title: Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias.
abstract: OBJECTIVE
  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 up 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.
authors.affiliation: Radiology Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy. francesco.decobelli@hsr.it
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pieroni
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.forename: Cristina
authors.initials: C
authors.lastname: Chimenti
authors.forename: Elena
authors.initials: E
authors.lastname: Belloni
authors.forename: Renata
authors.initials: R
authors.lastname: Mellone
authors.forename: Tamara
authors.initials: T
authors.lastname: Canu
authors.forename: Gianluca
authors.initials: G
authors.lastname: Perseghin
authors.forename: Carlo
authors.initials: C
authors.lastname: Gaudio
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
authors.forename: Andrea
authors.initials: A
authors.lastname: Frustaci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D006328:Cardiac Catheterization; D002303:Cardiac Output, Low / Q000209:etiology*; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage; D016679:Genome, Viral; D006801:Humans; D007089:Image Enhancement; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D009206:Myocardium / Q000473:pathology; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D005682:Gadolinium