Ces radiol. 2014, 68(4):311-317

Comprehensive approach to follow-up of patients after acute myocarditis including magnetic resonance - preliminary resultsOriginal article

Jakub Šedivý1, Jan Baxa2, Milan Hromádka1, Táňa Matoušková2, Richard Rokyta1, Jiří Ferda2
1 Kardiologické oddělení, Komplexní kardiovaskulární centrum FN, Plzeň
2 Klinika zobrazovacích metod LF UK a FN, Plzeň

Aim: Prospective study of patients following an acute myocarditis in order to assess the benefits and safety of regular monitoring using MRI, laboratory values of cardiac enzymes and exercise ECG.

Methods: 21 patients with acute myocarditis (diagnosis including the presence of late gadolinium enhancement - LGE at acute MR) underwent in 1 and 6 months interval a follow-up MRI, level of hypersensitive troponin I (hs-Tn) and the exercise ECG. Image analysis was focused on the development of LGE extent and intensity, results were compared with the development of hs-Tn and exercise ECG in 1 month follow-up.

Results: Preliminary results of the study prove regression of the extent and intensity of LGE in all patients and normal left ventricular systolic function in all patients in 1 and 6 months follow-up. This trend corresponds with the development of the average value of hs-Tn (from 9214.2 μg/l to 25.4 μg/l). During exercise ECG severe arrhythmia was not identified and all patients showed good tolerance of physical burden (at least 150 W).

Conclusion: Preliminary results of our study indicate that the combination of MR, the value of hs-Tn and exercise ECG is safe and beneficial for follow-up of patients after acute myocarditis. A thorough analysis at longer intervals is necessary for possible risk stratification of patients with regard to the duration of recommended rest interval duration.

Keywords: acute myocarditis, magnetic resonance, late gadolinium enhancement, exercise ECG, dilated cardiomyopathy
Grants and funding:

Podpořeno projektem Ministerstva zdravotnictví ČR Koncepční rozvoj výzkumné instituce 00669806 - FN Plzeň a Programem rozvoje vědních oborů Karlovy Univerzity (projekt P36).

Accepted: September 15, 2014; Published: December 1, 2014  Show citation

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Šedivý J, Baxa J, Hromádka M, Matoušková T, Rokyta R, Ferda J. Comprehensive approach to follow-up of patients after acute myocarditis including magnetic resonance - preliminary results. Ces radiol. 2014;68(4):311-317.
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    References

    1. Shauer A, Gotsman I, Keren A, et al. Acute viral myocarditis: current concepts in diagnosis and treatment. Isr Med Assoc J 2013; 15: 180-185.
    2. Stensaeth KH, Fossum E, Hoffmann P, Mangschau A, Klow NE. Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries. Int J Cardiovasc Imaging 2011; 27: 355-365. Go to original source... Go to PubMed...
    3. Abdel-Aty H, Boyé P, Zagrosek A, et al. Diagnostic performance of cardiovascular magnetic resonance in patiens with suspected acute myocarditis. J Am Coll Cardiol 2005; 45: 1815-1822. Go to original source... Go to PubMed...
    4. Gerbaud E, Harcaut E, Coste P, et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Int J Cardiovasc Imaging 2012; 28: 783-794. Go to original source... Go to PubMed...
    5. Vogel-Claussen J, Rochitte CE, Wu KC, et al. Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics 2006; 26: 795-810. Go to original source... Go to PubMed...
    6. Kindermann I, Kindermann M, Kandolf R, et al. Predictors of outcome in patients with suspected myocarditis. Circulation. 2008; 118: 639-648. Go to original source... Go to PubMed...
    7. Mavrogeni S, Spargias C, Bratis C, et al. Myocarditis as a precipitating factor for heart failure: evaluation and 1-year follow-up using cardiovascular magnetic resonance and endomyocardial biopsy. Eur J Heart Fail 2011; 13: 830-837. Go to original source... Go to PubMed...
    8. Karavidas A, Lazaros G, Noutsias M, et al. Recurrent coxsackie B viral myocarditis leading to progressive impairment of left ventricular function over 8 years. Int J Cardiol 2011; 151: e65-67. Go to original source... Go to PubMed...
    9. Baxa J, Ferda J, Rokyta R, Baxová L, Kreuzberg B. Úloha magnetické rezonance srdce v diagnostice akutní myokarditidy. Ces Radiol 2009; 63: 577-583.
    10. Grün S, Schumm J, Greulich S, et al. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol 2012; 59: 1604-1615. Go to original source... Go to PubMed...
    11. Dickerson JA, Raman SV, Baker PM, Leier CV. Relationship of cardiac magnetic resonance imaging and myocardial biopsy in the evaluation of nonischemic cardiomyopathy. Congest Heart Fail. 2013; 19: 29-38. Go to original source... Go to PubMed...
    12. De Smet K, Verdries D, Tanaka K, De Mey J, De Maeseneer M. MRI in the assessment of non ischemic myocardial diseases. Eur J Radiol 2012; 81: 1546-1548. Go to original source... Go to PubMed...
    13. Natale L, De Vita A, Baldari C, et al. Correlation between clinical presentation and delayed-enhancement MRI pattern in myocarditis. Radiol Med. 2012; 117: 1309-1319. Go to original source... Go to PubMed...
    14. Marholdt H, Goedecke C, Wagner A, et al. CMR assessment of human myocarditis; a comparison to histology and molecular pathology. Circulation 2004; 109: 1250-1258. Go to original source... Go to PubMed...
    15. Zagrosek A, Abdel-Aty H, Boyé P, et al. Cardiac magnetic resonance monitors reversible and irreversible myocardial injury in myocarditis. JACC Cardiovasc Imaging 2009; 2: 131-138. Go to original source... Go to PubMed...
    16. Wu KC, Weiss RG, Thiemann DR, et al. Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2414-2421. Go to original source... Go to PubMed...
    17. Laissy JP, Hyafil F, Feldman LJ, et al. Differentiating acute myocardial infarction from myocarditis: Diagnostic value of early- and delayed-Perfusion Cardiac MR imaging. Radiology 2005; 237: 75-82. Go to original source... Go to PubMed...
    18. Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging 2014; 7: 250-258. Go to original source... Go to PubMed...
    19. Magnani JW, Danik HJ, Dec GW Jr, DiSalvo TG. Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J 2006; 151: 463-470. Go to original source... Go to PubMed...
    20. Vermes E, Childs H, Faris P, Friedrich MG. Predictive value of CMR criteria for LV functional improvement in patients with acute myocarditis. Eur Heart J Cardiovasc Imaging 2014; 15: 1140-1144. Go to original source... Go to PubMed...
    21. Stensaeth KH, Hoffmann P, Fossum E, Mangschau A, Sandvik L, Klow NE. Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis. Int J Cardiovasc Imaging 2012; 28: 327-335. Go to original source... Go to PubMed...
    22. McLellan AJ, McKenzie SC, Taylor AJ. Cardiac magnetic resonance imaging predicts recovery of left ventricular function in acute onset cardiomyopathy. Heart Lung Circ 2012; 21: 30-35. Go to original source... Go to PubMed...
    23. D'Ambrosio A, Patti G, Manzoli A, et al. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 2001; 85: 499-504. Go to original source... Go to PubMed...
    24. Caforio AL, Paunkuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2014; 35: 2989-2995.
    25. De Stefano L, Perez de Arenaza D, Yeyati EL, et al. Low rate of cardiovascular events in patients with acute myocarditis diagnosed by cardiovascular magnetic resonance. Cardiovasc Diagn Ther 2014; 4: 64-70.

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