Myocardial biopsy findings and gadolinium enhanced cardiovascular magnetic resonance in dilated cardiomyopathy.
BACKGROUND
In some patients suffering from dilated cardiomyopathy (DCM) magnetic resonance imaging (MRI) shows late gadolinium enhancement with variable distribution. Myocardial biopsies in DCM reveal a chronic myocardial inflammatory process in almost 50% and myocardial persistence of adenoviral or enteroviral genome in about 15% of the patients.


OBJECTIVE
We prospectively investigated whether the pattern of late gadolinium enhancement correlates with myocardial biopsy findings.


RESULTS
42 patients with DCM and 42 control subjects underwent contrast MRI. In the DCM group, endomyocardial biopsies were performed and evaluated for inflammation and viral genome. None of the control subjects showed late gadolinium enhancement whereas in 29 DCM patients (69%) gadolinium enhancement was detectable (p<0.001). 21 of the DCM patients (50%) showed midwall septal enhancement, 7 patients (17%) showed a patchy distribution of hyperenhancement and 1 patient (2%) showed enhancement typical for ischemic heart disease. In myocardial biopsy analysis, 2 patients (5%) showed persistence of viral genome, 18 patients (43%) showed inflammation and in 22 patients (52%) neither virus nor inflammation was detected. The pattern of late gadolinium enhancement and myocardial biopsy findings were not significantly correlated (p = 0.854).


CONCLUSIONS
MRI as a non-invasive technique cannot replace myocardial biopsy for the differential diagnosis of DCM.
Zimmermann
Oliver
O
Department of Internal Medicine II-Cardiology, University of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany. oliver.zimmerman@medizin.uni-ulm.de
Grebe
Olaf
O
Merkle
Nico
N
Nusser
Thorsten
T
Kochs
Matthias
M
Bienek-Ziolkowski
Magdalena
M
Hombach
Vinzenz
V
Torzewski
Jan
J
D000328:Adult; D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement; D007249:Inflammation / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology* / Q000648:ultrastructure; D011446:Prospective Studies
D005682:Gadolinium