Relationship between cardioscopic images and histological changes in the left ventricle of patients with idiopathic myocarditis.
OBJECTIVE
Endomyocardial biopsy is essential for definite diagnosis of idiopathic myocarditis. However, since endomyocardial biopsy is guided by fluoroscopy, whether or not the diseased myocardium is biopsied depends on chance, and this may lead to misdiagnosis. If the endocardial surface represents changes indicative of stages of myocarditis, staging of myocarditis and targeted cardioscope-guided biopsy could be used for accurate histological diagnosis.


RESULTS
The relationship between left ventricular endocardial surface colour observed by cardioscopy and biopsy findings were examined in 78 patients with suspected idiopathic myocarditis. Of these, 59 patients were diagnosed histologically as idiopathic myocarditis. Endocardial colour was classified into red, milky white, purple, yellowish brown, or white. Biopsied specimens with red and milky white wall segments exhibited histological changes compatible with acute myocarditis; purple segments, active chronic myocarditis; and yellowish brown and white segments, inactive chronic myocarditis. The sensitivity, specificity, and predictive value of red and milky white colours for detecting acute myocarditis were 100, 100, and 100%, respectively; of purple for detecting active chronic myocarditis were 83, 92, and 78%, respectively; and yellowish brown and white for detecting inactive chronic myocarditis were 82, 74, and 53, respectively.


CONCLUSIONS
Red and milky white endocardial surface colours predicted histological acute myocarditis, and purple predicted active chronic myocarditis. However, yellowish brown and white colours did not predict inactive chronic myocarditis.
Japan Foundation for Cardiovascular Research, Toho University Sakura Hospital and Funabashi-Futawa Hospital, 2-30-17 Narashinodai, Funabashi, Japan.
Yasumi
Y
Uchida
Yasuto
Y
Uchida
Takeshi
T
Sakurai
Masahito
M
Kanai
Seiichiro
S
Shirai
Osamu
O
Nakagawa
Nobuyuki
N
Hiruta
D000328:Adult; D001706:Biopsy / Q000379:methods; D002908:Chronic Disease; D003116:Color; D004699:Endocardium / Q000473:pathology*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D009205:Myocarditis / Q000145:classification / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D012680:Sensitivity and Specificity
J Am Coll Cardiol. 2003 Aug 6;42(3):466-72
12906974
Herz. 2000 May;25(3):221-6
10904842
Herz. 2005 Sep;30(6):535-44
16170686
Lab Invest. 2000 Jul;80(7):1137-42
10908160
Pediatr Cardiol. 2005 Jan-Feb;26(1):45-9
15793653
Prog Cardiovasc Dis. 2006 Jul-Aug;49(1):42-57
16867849
Internist (Berl). 2008 Jan;49(1):7-16
18210028
Am Heart J. 1990 Apr;119(4):949-52
2321512
Am Heart J. 1990 Sep;120(3):677-87
2389703
Jpn Heart J. 2000 Jan;41(1):41-7
10807528
Circulation. 2010 Aug 31;122(9):900-9
20713901
Hum Pathol. 2009 Jul;40(7):1015-22
19297005
Hum Pathol. 1987 Jun;18(6):619-24
3297992
Circulation. 2006 Jan 31;113(4):593-5
16449736
Histopathology. 2001 Apr;38(4):338-43
11318899