Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias
Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias
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DOI：
10.1016/j.jacc.2005.11.067
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Del Maschio, A
中科院分区：
文献类型：
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作者：
de Cobelli, F;Pieroni, M;Del Maschio, A
我们评价了对比增强心脏磁共振（CE-CMR）在检测慢性心肌炎（CM）中的有效性。虽然CE-CMR已被证明是有效的，在确定急性心肌炎的心肌损伤的领域，其作用在慢性心肌炎症的诊断尚未被investigated.METHODS 23例CM进行了CE-CMR和肌内膜活检（EMB）。慢性心肌炎的定义是存在。1)慢性（> 6个月）心力衰竭症状和/或反复性室性心律失常; 2）近期无流感样症状或感染史;和3）根据达拉斯标准，有活动性心肌炎（AM）或临界性心肌炎（BM）的组织学证据。对比增强心脏磁共振成像包括黑血T2加权（BBT 2 W）图像没有和脂肪饱和和延迟三维T1涡轮场回波反转恢复序列获得后15分钟钆injection.Results组织学显示AM在14例和BM在9例。FatSat BBT 2 w显示5例（36%）AM患者存在水肿，但BM患者无水肿。在12例（84%）AM受试者和4例（44%）BM受试者中观察到晚期增强（LE）区域。两组中最常见的发现是壁中LE模式，而仅在AM患者中观察到LE的心外膜下分布。结论对比增强心脏磁共振识别了70%活检证实CM的患者的Lip心肌炎症区域。我们认为，CE-CMR可能是一个有用的非侵入性诊断工具，在CM患者，它可以指示，甚至指导左心室EMB的执行与相关的预后和治疗意义。
OBJECTIVES We evaluated the effectiveness of contrast-enhanced cardiac magnetic resonance (CE-CMR) in detecting chronic myocarditis (CM).BACKGROUND Chronic myocarditis represents a common evolution of acute myocarditis. Although CE-CMR has been revealed to be effective in identifying areas of myocardial damage in acute myocarditis, its role in the diagnosis of chronic myocardial inflammation has not yet been investigated.METHODS Twenty-three patients with CM underwent CE-CMR and endomyocardial biopsy (EMB). Chronic myocarditis was defined by the presence of. 1) chronic (> 6 months) heart failure symptoms and/or repetitive ventricular arrhythmias; 2) no history of recent flu-like symptoms or infections; and 3) histologic evidence of active myocarditis (AM) or borderline myocarditis (BM) according to Dallas criteria. Contrast-enhanced cardiac magnetic resonance included black-blood T2-weighted (BBT2w) images without and with fat saturation and delayed three-dimensional T1 turbo field-echo inversion-recovery sequences obtained 15 min after gadolinium injection.RESULTS Histology showed AM in 14 patients and BM in 9 patients. FatSat BBT2w revealed the presence of edema in five (36%) patients with AM but not in BM patients. Areas of late enhancement (LE) were observed in 12 (84%) subjects with AM and in 4 (44%) cases with BM. A mid-wall LE pattern was the most frequent finding in both groups while a subepicardial distribution of LE was observed only in patients with AM.CONCLUSIONS Contrast-enhanced cardiac magnetic resonance identified areas of myocardial inflammation in Lip to 70% of patients with biopsy-proven CM.. We suggest that CE-CMR may be a useful non-invasive diagnostic tool in patients with CM, and it may indicate and even guide the execution of left ventricular EMB with relevant prognostic and therapeutic implications.