[Antimyosin scintigraphy for diagnosis and follow-up of patients with clinically suspected myocarditis].
Antimyosin-scintigraphy is believed to have a high specificity but a low sensitivity for the diagnosis of myocarditis when histological analysis of endomyocardial biopsy is used as the reference method. However, the histological evaluation itself seems to have a low sensitivity for the diagnosis of myocarditis. Therefore, immunohistological techniques have been developed for the detection of lymphocytic infiltrates and increased expression of HLA antigens in the myocardium. The present study compares the results of antimyosin-scintigraphy with histological and immunohistological analysis of the endomyocardial biopsy. 65 patients with clinically suspected myocarditis underwent antimyosin-scintigraphy and histological and immunohistological analysis of the endomyocardial biopsy. Myocarditis could be diagnosed histologically in only 9/36 (25%) patients with a positive antimyosin scan but additional immunohistological analysis revealed lymphocytic infiltrates in 31 (86%) of these patients. In 29 patients with a normal antimyosin scan, histological analysis showed evidence of myocarditis in 3 (10%) patients; additional immunohistological evaluation disclosed lymphocytic infiltrates in 17 (59%) patients. With immunohistological analysis of the endomyocardial biopsy as the reference method, antimyosin-scintigraphy has a high sensitivity but a lower specificity for the diagnosis of myocarditis. Detection of autoantibodies against human cardiac myosin in patients with myocarditis is associated with a significantly lower incidence of positive antimyosin scans in these patients. Antimyosin-scintigraphy was repeated after six months in 14 patients with myocarditis. Histological and immunohistological evaluation of the endomyocardial biopsy now showed persistent myocarditis in 3/8 patients with a positive antimyosin scan and in 5/6 patients with a normal antimyosin scan.
Lauer
B
B
Klinik für Innere Medizin/Kardiologie, Universität Leipzig-Herzzentrum.
Kühl
U
U
Souvatzoglu
M
M
Vosberg
H
H
Schultheiss
H P
HP
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002908:Chronic Disease; D004699:Endocardium / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D009218:Myosins / Q000276:immunology*; D009942:Organometallic Compounds; D016719:Radioimmunodetection; D012680:Sensitivity and Specificity
D000911:Antibodies, Monoclonal; D001323:Autoantibodies; D009942:Organometallic Compounds; C058899:imciromab pentetate; D009218:Myosins
Antimyosin-Szintigraphie zur Diagnostik und Verlaufskontrolle bei Patienten mit klinischem Verdacht auf Myokarditis.