title: Antimyosin scintigraphy and immunohistologic analysis of endomyocardial biopsy in patients with clinically suspected myocarditis--evidence of myocardial cell damage and inflammation in the absence of histologic signs of myocarditis.
abstract: OBJECTIVE
  This study compares the results of antimyosin scintigraphy in patients with clinically suspected myocarditis with histologic and immunohistologic findings in the endomyocardial biopsy.
  
  
  BACKGROUND
  In patients with clinically suspected myocarditis, antimyosin scintigraphy often demonstrates myocardial cell damage but histologic evaluation of the endomyocardial biopsy often fails to show evidence of myocarditis. Recently developed immunohistologic techniques appear to be more sensitive for the detection of myocardial inflammation than histologic analysis alone. Studies comparing antimyosin scintigraphy and immunohistologic analysis of the endomyocardial biopsy in patients with clinically suspected myocarditis are not yet available.
  
  
  METHODS
  Sixty-five patients with clinically suspected myocarditis underwent antimyosin scintigraphy. Antimyosin antibody uptake was correlated with histologic and immunohistologic findings in the endomyocardial biopsy.
  
  
  RESULTS
  Antimyosin scintigraphy showed evidence of myocardial cell damage in 36 (55%) of the 65 patients and was negative in 29 (45%) patients. Histologic analysis of the endomyocardial biopsy revealed myocarditis in nine patients: six had a positive and three had a negative antimyosin scan, respectively. Thirty (83%) of 36 patients with evidence of myocardial cell damage on antimyosin scintigraphy were histologically negative for myocarditis. Immunohistologic analysis showed evidence of myocarditis in 31 (86%) of 36 patients with a positive antimyosin scan and also in 17 (59%) of 29 patients with a normal scan (p < 0.047).
  
  
  CONCLUSIONS
  Antimyosin scintigraphy often shows myocyte injury in patients with clinically suspected myocarditis. Histologic analysis of the endomyocardial biopsy alone is often negative, but additional immunohistologic analysis of the endomyocardial biopsy frequently provides evidence of myocardial inflammation in these patients. With immunohistologic analysis as the reference method, antimyosin scintigraphy has a high specificity but a lower sensitivity for the detection of myocarditis.
authors.affiliation: Universitätsklinikum Benjamin Franklin, Abteilung Kardiologie, Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kühl
authors.forename: B
authors.initials: B
authors.lastname: Lauer
authors.forename: M
authors.initials: M
authors.lastname: Souvatzoglu
authors.forename: H
authors.initials: H
authors.lastname: Vosberg
authors.forename: H P
authors.initials: HP
authors.lastname: Schultheiss
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D009218:Myosins / Q000276:immunology*; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume
chemical_list: D000911:Antibodies, Monoclonal; D009218:Myosins