title: Utility of combination of cardiac magnetic resonance imaging and high-sensitivity cardiac troponin T assay in diagnosis of inflammatory cardiomyopathy.
abstract: We evaluated the clinical utility of cardiac magnetic resonance imaging (CMR) combined with a novel high-sensitivity troponin T assay (hs-cTnT) in the diagnosis of inflammatory cardiomyopathy. CMR, measurement of hs-cTnT, and endomyocardial biopsy were performed in 42 patients with dilated cardiomyopathy and a short-term history of heart failure (median 2 months, interquartile range 1 to 3.5). The patients were followed up for 25 ± 9 months for events. Endomyocardial biopsy revealed myocarditis in 15 subjects (36%). The sensitivity, specificity, and diagnostic accuracy of the individual CMR tissue parameters for myocardial inflammation was 40%, 96%, and 76% for early gadolinium enhancement, 87%, 44%, and 60% for late gadolinium enhancement, 47%, 89%, and 74% for pericardial effusion, and 67%, 85%, and 79% for any 2 of the criteria simultaneously, respectively. An assessment of myocardial edema on T(2)-weighted imaging and/or hs-cTnT assay were inadequate for the diagnosis. The extent of late gadolinium enhancement and increased hs-cTnT concentration were significant predictors of a composite end point of cardiac death, urgent heart transplantation, and hospitalization for worsening heart failure (hazard ratio 1.1, 95% confidence interval 1.0 to 1.2, per percentage of left ventricular mass; and hazard ratio 2.2, 95% confidence interval 1.4 to 3.5, per ln ng/L; p = 0.008 and p = 0.001, respectively). In conclusion, the results of the present study have demonstrated a modest performance for CMR and a limited use of the hs-cTnT assay in the diagnosis of inflammatory cardiomyopathy. Nonetheless, in these patients, CMR and/or hs-cTnT assessment seems to be useful for the prediction of the clinical outcome.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. marek.sramko@ikem.cz
authors.forename: Marek
authors.initials: M
authors.lastname: Šramko
authors.forename: Miloš
authors.initials: M
authors.lastname: Kubánek
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Tintěra
authors.forename: Dana
authors.initials: D
authors.lastname: Kautznerová
authors.forename: Jiří
authors.initials: J
authors.lastname: Weichet
authors.forename: Jana
authors.initials: J
authors.lastname: Malušková
authors.forename: Janka
authors.initials: J
authors.lastname: Franeková
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
mesh_terms: D000328:Adult; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019028:Magnetic Resonance Imaging, Cine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T