title: Detection of myocarditis by contrast-enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis.
abstract: 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.
authors: 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
authors: Andrei
authors: A
authors: Codreanu
authors: Wassila
authors: W
authors: Djaballah
authors: Michael
authors: M
authors: Angioi
authors: Gérard
authors: G
authors: Ethevenot
authors: Frederic
authors: F
authors: Moulin
authors: Jacques
authors: J
authors: Felblinger
authors: Nicolas
authors: N
authors: Sadoul
authors: Gilles
authors: G
authors: Karcher
authors: Etienne
authors: E
authors: Aliot
authors: Pierre Y
authors: PY
authors: Marie
mesh_terms: 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
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019210:Troponin I; D002097:C-Reactive Protein; D017256:Technetium Tc 99m Sestamibi; D019786:Gadolinium DTPA