Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis--a CMR study.
BACKGROUND
Myocardial edema is a substantial feature of the inflammatory response in human myocarditis. The relation between myocardial edema and myocardial mass in the course of healing myocarditis has not been systematically investigated. We hypothesised that the resolution of myocardial edema as visualised by T2-weighted cardiovascular magnetic resonance (CMR) is associated with a decrease of myocardial mass in steady state free precession (SSFP)-cine imaging.


METHODS
21 patients with acute myocarditis underwent CMR shortly after onset of symptoms and 1 year later. For visualization of edema, a T2-weighted breath-hold black-blood triple-inversion fast spin echo technique was applied and the ratio of signal intensity of myocardium/skeletal muscle was assessed. Left ventricular (LV) mass, volumes and function were quantified from biplane cine steady state free precession images. 11 healthy volunteers served as a control group for interstudy reproducibility of LV mass.


RESULTS
In patients with myocarditis, a significant decrease in LV mass was observed during follow-up compared to the acute phase (156.7 +/- 30.6 g vs. 140.3 +/- 28.3 g, p < 0.0001). The reduction of LV mass paralleled the normalization of initially increased myocardial signal intensity on T2-weighted images (2.4 +/- 0.4 vs. 1.68 +/- 0.3, p < 0.0001). In controls, the interstudy difference of LV mass was lower than in patients (5.1 +/- 2.9 g vs. 16.3 +/- 14.2 g, p = 0.02) resulting in a lower coefficient of variability (2.1 vs 8.9%, p = 0.04).


CONCLUSIONS
Reversible abnormalities in T2-weighted CMR are paralleled by a transient increase in left ventricular mass during the course of myocarditis. Myocardial edema may be a common pathway explaining these findings.
Zagrosek
Anja
A
Franz-Volhard-Klinik, Charité-Campus Buch, Humboldt-University Berlin, Helios-Klinikum, Germany. zagrosek@gmx.de
Wassmuth
Ralf
R
Abdel-Aty
Hassan
H
Rudolph
André
A
Dietz
Rainer
R
Schulz-Menger
Jeanette
J
D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D017023:Coronary Angiography; D004487:Edema / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D016277:Ventricular Function, Left