title: Myocardial inflammation in autoimmune diseases: investigation by cardiovascular magnetic resonance and endomyocardial biopsy.
abstract: BACKGROUND
  Myocardial inflammation often coexists with different types of autoimmune diseases. Our aim was to investigate the presence of myocarditis in these patients by Cardiovascular Magnetic Resonance (CMR) and endomyocardial biopsy.
  
  
  METHODS
  Twenty patients, aged 20-55 yrs with autoimmune diseases and cardiac symptoms (3 with Takayasu's arteritis, 3 with systemic lupus erythematosus, 5 with rheumatoid arthritis, 7 with autoimmune thyroid disease and 2 with systemic sclerosis) and 20 patients with the same autoimmune diseases but without cardiac symptoms (controls) were studied. The presence of myocarditis and LV function were evaluated by CMR. Myocarditis was documented using T2-weighted (T2-W), T1-weighted (T1-W) before and after contrast media injection and late enhanced images. In 10 patients (positive for myocarditis by CMR with either low LVEF or recent increase in troponin), endomyocardial biopsy was also performed. Myocardial specimens were evaluated by histology and polymerase chain reaction techniques (PCR).
  
  
  RESULTS
  Myocarditis was identified in 18/20 patients by CMR. In the T2-W images the signal ratio of myocardium to skeletal muscle was 1.89+/-0.25 (control values 1.57+/-0.13, p<0.05). From the T1-W images the relative myocardial enhancement was 11.31+/-11.18 (control values 3.09+/-0.05, p<0.05). Epicardial late gadolinium enhanced areas were identified in 18/20. In myocardial specimens, histology revealed inflammation in 5/10 (50%) and PCR documented viral or microbial genomes in 8/10 (80%). Positive histology and PCR were in agreement with 50% and 80% of positive CMR examinations, respectively. Herpes virus was identified in 3/10, Adeno in 1/10, Coxsackie B6 in 1/10, echo in 1/10, Parvo-B19 in 3/10, CMV in 1/10 and Chlamydia trachomatis in 8/10.
  
  
  CONCLUSIONS
  Myocardial inflammation is a common finding in patients with autoimmune diseases and cardiac symptoms. The diagnosis can be confirmed by CMR, which is a noninvasive and reliable tool for the investigation of these patients.
authors.affiliation: Onassis Cardiac Surgery Center, Esperou Street, 175-61 P.Faliro, Greece. soma13@otenet.gr
authors.forename: Sophie
authors.initials: S
authors.lastname: Mavrogeni
authors.forename: Kostas
authors.initials: K
authors.lastname: Spargias
authors.forename: Vyron
authors.initials: V
authors.lastname: Markussis
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
authors.forename: Eftichia
authors.initials: E
authors.lastname: Demerouti
authors.forename: Evangelia
authors.initials: E
authors.lastname: Papadopoulou
authors.forename: George
authors.initials: G
authors.lastname: Stavridis
authors.forename: Loukas
authors.initials: L
authors.lastname: Kaklamanis
authors.forename: Marouso
authors.initials: M
authors.lastname: Douskou
authors.forename: Pantelis
authors.initials: P
authors.lastname: Constantoulakis
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications*; D001706:Biopsy; D004266:DNA Virus Infections / Q000175:diagnosis; D005682:Gadolinium; D016679:Genome, Viral; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D009206:Myocardium / Q000276:immunology / Q000473:pathology; D012327:RNA Virus Infections / Q000175:diagnosis; D014780:Viruses / Q000302:isolation & purification
chemical_list: D005682:Gadolinium