Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias.
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.
De Cobelli
Francesco
F
Radiology Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy. francesco.decobelli@hsr.it
Pieroni
Maurizio
M
Esposito
Antonio
A
Chimenti
Cristina
C
Belloni
Elena
E
Mellone
Renata
R
Canu
Tamara
T
Perseghin
Gianluca
G
Gaudio
Carlo
C
Maseri
Attilio
A
Frustaci
Andrea
A
Del Maschio
Alessandro
A
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
D005682:Gadolinium