Comprehensive Cardiac Magnetic Resonance for Short-Term Follow-Up in Acute Myocarditis.
Comprehensive Cardiac Magnetic Resonance for Short-Term Follow-Up in Acute Myocarditis.
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急性心肌炎短期随访的综合心脏磁共振。
DOI：
10.1161/jaha.116.003603
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发表时间：
2016-07-19
影响因子：
5.4
通讯作者：
Thomas DK
中科院分区：
文献类型：
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作者：
Luetkens JA;Homsi R;Dabir D;Kuetting DL;Marx C;Doerner J;Schlesinger-Irsch U;Andrié R;Sprinkart AM;Schmeel FC;Stehning C;Fimmers R;Gieseke J;Naehle CP;Schild HH;Thomas DK
心脏磁共振（CMR）可以检测疑似急性心肌炎患者的炎症性心肌改变。在疾病过程中，关于CMR参数的正常化程度的信息有限，在此期间定量CMR应该最合理地用于诊断工作的时间窗口。24例疑似急性心肌炎患者和45例对照组接受了CMR检查。入院后2.6±1.9天进行首次CMR。心肌炎患者分别在2.4±0.6、5.5±1.3和16.2±9.9周后接受CMR随访。CMR方案包括评估标准Lake Louise标准、T1松弛时间、细胞外体积分数和T2松弛时间。心肌炎患者与对照组在疾病急性期的组间差异最大（所有参数P<0.001）。在整个病程中，所有炎症性CMR参数均有显著且一致的下降（所有参数P<0.01）。在5.5±1.3周的随访中，心肌T1和T2舒张时间是心肌炎患者与对照组之间唯一显示显著差异的单一参数（T1: 986.5±44.4 ms vs 965.1±28.1 ms， P=0.022; T2: 55.5±3.2 ms vs 52.6±2.6 ms， P=0.001）。在急性心肌炎患者中，心肌炎症的CMR标记物在几次随访检查中显示出快速和持续的下降。因此，CMR诊断心肌炎应尝试在疾病的早期阶段。心肌T1和T2松弛时间是区分心肌炎患者和对照组（即使在疾病恢复期）活动性炎症/水肿的唯一参数。
Cardiac magnetic resonance (CMR) can detect inflammatory myocardial alterations in patients suspected of having acute myocarditis. There is limited information regarding the degree of normalization of CMR parameters during the course of the disease and the time window during which quantitative CMR should be most reasonably implemented for diagnostic work‐up. Twenty‐four patients with suspected acute myocarditis and 45 control subjects underwent CMR. Initial CMR was performed 2.6±1.9 days after admission. Myocarditis patients underwent CMR follow‐up after 2.4±0.6, 5.5±1.3, and 16.2±9.9 weeks. The CMR protocol included assessment of standard Lake Louise criteria, T1 relaxation times, extracellular volume fraction, and T2 relaxation times. Group differences between myocarditis patients and control subjects were highest in the acute stage of the disease (P<0.001 for all parameters). There was a significant and consistent decrease in all inflammatory CMR parameters over the course of the disease (P<0.01 for all parameters). Myocardial T1 and T2 relaxation times—indicative of myocardial edema—were the only single parameters showing significant differences between myocarditis patients and control subjects on 5.5±1.3‐week follow‐up (T1: 986.5±44.4 ms versus 965.1±28.1 ms, P=0.022; T2: 55.5±3.2 ms versus 52.6±2.6 ms; P=0.001). In patients with acute myocarditis, CMR markers of myocardial inflammation demonstrated a rapid and continuous decrease over several follow‐up examinations. CMR diagnosis of myocarditis should therefore be attempted at an early stage of the disease. Myocardial T1 and T2 relaxation times were the only parameters of active inflammation/edema that could discriminate between myocarditis patients and control subjects even at a convalescent stage of the disease.