Detection of myocarditis by contrast-enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis.
OBJECTIVE
To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis.


METHODS
A total of 27 consecutive patients (age = 45 +/- 17 years; 14 male) presenting with ACS (chest pain, positive troponin-I) and no coronary stenosis, underwent cardiac MRI 9 +/- 7 days after pain onset and 8 +/- 5 months later (N = 19). Steady-state free-precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion-recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi-gated-single photon emission CT (SPECT) was also systematically performed.


RESULTS
Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C-reactive protein (CRP) levels (38 +/- 32 vs. 14 +/- 24 mg/mL; P = 0.04), lower Framingham cardiovascular risk (3 +/- 3% vs. 9 +/- 5%; P < 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P = 0.01), higher left ventricular (LV) end-diastolic volume (77 +/- 16 vs. 64 +/- 10 mL/m(2); P = 0.02), and higher regression of DCE areas at follow-up (-65 +/- 17% vs. -18 +/- 23%; P = 0.002).


CONCLUSIONS
DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis.
Codreanu
Andrei
A
Department of Cardiology, Institut National de la Santé et de la Recherche Médicale (INSERM) U684, Centre Hospitalier Universitaire (CHU)-Nancy, France. codreanu.andrei@chl.lu
Djaballah
Wassila
W
Angioi
Michael
M
Ethevenot
Gérard
G
Moulin
Frederic
F
Felblinger
Jacques
J
Sadoul
Nicolas
N
Karcher
Gilles
G
Aliot
Etienne
E
Marie
Pierre Y
PY
D000208:Acute Disease; D002097:C-Reactive Protein / Q000032:analysis; D002637:Chest Pain / Q000175:diagnosis*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D019210:Troponin I / Q000097:blood
D003287:Contrast Media; D019275:Radiopharmaceuticals; D019210:Troponin I; D002097:C-Reactive Protein; D017256:Technetium Tc 99m Sestamibi; D019786:Gadolinium DTPA