Transient ventricular wall thickening in acute myocarditis - A serial echocardiographic and histopathologic study

The present study was designed to determine whether the wall thickening seen in acute myocarditis is caused by interstitial edema. The study group comprised 25 patients (idiopathic myocarditis, 17; eosinophilic myocarditis, 8) in whom acute myocarditis was diagnosed histologically and who underwent echocardiography and endomyocardial biopsy during both the acute and convalescent phases. The following echocardiographic parameters were measured: interventricular septum and left ventricular posterior wall thickness, left ventricular end-diastolic dimension, and left ventricular ejection fraction. Based on the myocardial biopsy specimens, the degree of interstitial edema was classified into 3 grades [(-), 1(+), 2(+)] and the transverse diameter of cardiac myocytes was measured using light microscopy. The thickness of both the interventricular septum and left ventricular wall decreased from 14.3 +/-3.7 mm and 13.3 +/-2.4 mm in the acute phase to 9.7 +/-1.7 mm (p <0.001) and 10.2 +/-1.7 mm (p <0.0001), respectively, in the convalescent phase. Edema was present in 22 patients (88.0%) in the acute phase, but in the convalescent phase, edema was present in only 7 patients (28.0%), indicating a significant reduction in the degree of edema (p <0.0001). Cardiac myocyte diameter did not differ significantly between the acute (13.6 +/-1.1 mum) and convalescent (13.8 +/-1.8 mum) phases.