Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults--towards identification of myocardial inflammation.
OBJECTIVE
To assess active myocardial inflammation by cardiovascular magnetic resonance (CMR) and endomyocardial biopsy (EMB) amongst adult patients with dilated cardiomyopathy (DCM).


METHODS
We evaluated 23 adults with chronic DCM, who had successfully undergone both CMR and EMB within 3.5 ± 2.6 days. EMB was considered the gold standard. CMR assessment of myocardial inflammation used the following parameters as recommended by the recently published "Lake Louise Criteria": global myocardial oedema, global relative enhancement (RE), and late gadolinium enhancement (LGE). According to "Lake Louise Criteria", myocardial inflammation was diagnosed if two or more of the three above-mentioned parameters were positive.


RESULTS
Myocardial inflammation was confirmed by immunohistology in 12 patients (52.2%). Sensitivity, specificity, and diagnostic accuracy of CMR to detect immunohistologically confirmed myocardial inflammation were 75.0%, 72.7%, and 73.9%, respectively. Sensitivity, specificity, and diagnostic accuracy of the individual CMR parameters to detect myocardial inflammation were as follows: global myocardial oedema, 91.7%, 81.8%, and 87.0%, respectively; global RE, 58.3%, 63.6%, and 60.9%, respectively; LGE, 58.3%, 45.4%, and 52.2%, respectively.


CONCLUSIONS
Global myocardial oedema was identified as a promising CMR parameter for assessment of myocardial inflammation in patients with DCM. In these patients, global myocardial oedema yielded superior diagnostic performance compared to "Lake Louise Criteria".
Department of Cardiology, Campus Mitte, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Antje
A
Voigt
Thomas
T
Elgeti
Tahir
T
Durmus
Merve Ece
ME
Idiz
Craig
C
Butler
Mark
M
Beling
Rene
R
Schilling
Karin
K
Klingel
Reinhard
R
Kandolf
Karl
K
Stangl
Matthias
M
Taupitz
Dietmar
D
Kivelitz
Moritz
M
Wagner
D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000473:pathology*; D004452:Echocardiography / Q000379:methods; D004487:Edema / Q000473:pathology; D005260:Female; D005682:Gadolinium / Q000494:pharmacology; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D005682:Gadolinium