Long-term follow-up of patients with acute myocarditis by magnetic resonance imaging

Anja Wagner1, Jeanette Schulz-Menger1, Rainer Dietz1, Matthias G. Friedrich1
1Franz-Volhard-Klinik, Working group 'Cardiac Magnetic Resonance', Charité Campus Buch, Humboldt University, Berlin, Germany

Tóm tắt

Magnetic resonance imaging (MRI) reveals cardiac signal intensity changes in patients with acute myocarditis; however, the natural history of these changes and their relationship to individual outcomes are unknown. The relationship of MRI findings to long-term outcome was studied by serial MRI studies in 16 patients with acute myocarditis who were followed for 30±4 (SE) months. Myocardial contrast enhancement was monitored using contrast-enhanced T1-weighted fast spin-echo images. Left ventricular ejection fraction was measured with gradient-echo sequences. Clinical symptoms were scored. The results were compared to a control group of 26 age-matched, healthy volunteers. Myocardial contrast enhancement, which was markedly increased in the early course of the disease, decreased at 4 weeks and remained within the normal range in most patients after 30 months. Contrast enhancement 4 weeks after onset of symptoms was predictive for the functional and clinical long-term outcome. Contrast-enhanced MRI may be a useful, noninvasive tool for long-term follow-up of patients with acute myocarditis. Furthermore, relatively early MRI findings may predict longer-term outcomes.

Tài liệu tham khảo

Kishimoto C, Hiraoka Y (1994) Clinical and experimental studies in myocarditis. Curr Opin Cardiol 9:349–356 Fuster V, Gersh BJ, Giuliani ER, Tajik AJ, Brandenburg RO, Frye RL (1981) The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 47:525–531 Kawai C (1999) From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 99:1091–1100 Alpert JS CM (1996) Update in cardiology: myocarditis (published erratum appears in Ann Intern Med 1996 Sep 1;125(5):428). Ann Int Med 125:40–46 Brown CA OCJ (1996) Implications of the Myocarditis Treatment Trial for clinical practice. Curr Opin Cardiol 11:332–336 Grogan M, Redfield MM, Bailey KR et al (1995) Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 26:80–84 Morguet AJ MD, Kreuzer H, Emrich D (1994) Scintigraphic detection of inflammatory heart disease. Eur J Nucl Med 21:666–674 Yamada T, Matsumori A, Tamaki N, Nohara R, Konishi J. Sasayama S (1997) Indium-111 antimyosin antibody imaging and thallium-201 imaging--a comparative myocardial scintigraphic study using single-photon emission computed tomography in patients with myocarditis and dilated cardiomyopathy. Jpn Circ J 61:827–835 Yasuda T, Palacios IF, Dec GW, Fallon JT, Gold HK, Leinbach RC, Strauss HW, Khaw BA, Haber E (1987) Indium 111-monoclonal antimyosin antibody imaging in the diagnosis of acute myocarditis. Circulation 76:306–11 Dec GW, Jr., Palacios IF, Fallon JT, et al (1985) Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome. N Engl J Med 312:885–890 Friedrich MG, Strohm O, Schulz Menger J, Marciniak H, Luft FC, Dietz R (1998) Contrast media[sic]-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation 97:1802–9 Aso H, Takeda K, Ito T, Shiraishi T, Matsumura K, Nakagawa T (1998) Assessment of myocardial fibrosis in cardiomyopathic hamsters with gadolinium-DTPA enhanced magnetic resonance imaging. Invest Radiol 33:22–32 Martino TA, Liu P, Sole MJ (1994) Viral infection and the pathogenesis of dilated cardiomyopathy. Circ Res 74:182–188