title: [Contribution of cardiac MRI in the initial evaluation and follow-up of myocarditis mimicking acute coronary syndrome: a series of 43 patients].
abstract: OBJECTIVE
  The diagnosis of acute myocarditis is complex, especially when the clinical presentation mimics an acute coronary syndrome. This condition may promote the progression to dilated cardiomyopathy and the occurrence of severe arrhythmias. A reassessment integrating a cardiac MRI at three months after the acute episode could help identify patients with a poor prognosis.
  
  
  RESULTS
  This prospective series of 43 consecutive patients hospitalised for acute myocarditis included 36 men and seven women, with a mean age of 32 years, with no indication of heart failure. All patients presented elevated levels of troponin I. Echocardiography showed moderate left ventricular dysfunction in six cases and segmental wall motion abnormalities in 22 cases. After gadolinium injection, a subepicardial late enhancement was observed in 39 cases. Three months after the acute episode, all patients were asymptomatic. The echocardiography and laboratory tests were normal. In 23 cases, the MRI showed persistence of the late enhancement without segmental wall motion abnormality. After a mean follow-up of three years, one patient was lost to follow-up and only one suffered a heart failure revealing a dilated cardiomyopathy complicated by ventricular arrhythmias.
  
  
  CONCLUSIONS
  On admission, the subepicardial localisation of late enhancement in the cardiac MRI is reliable criteria for the diagnosis of acute myocarditis, enabling to rule out an acute coronary syndrome. During follow-up, the persistence of late enhancement has no impact on prognosis. In this series, after a mean follow-up of three years, it was not associated with clinical or paraclinical abnormalities, except in one patient.
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France. Electronic address: philippe.paule@orange.fr.
authors.forename: P
authors.initials: P
authors.lastname: Paule
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France.
authors.forename: N-C
authors.initials: NC
authors.lastname: Roche
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Chabrillat
authors.affiliation: Service de cardiologie, hôpital La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: J
authors.initials: J
authors.lastname: Quilici
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Jégo
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France.
authors.forename: U
authors.initials: U
authors.lastname: Vinsonneau
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Kérébel
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Gil
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France.
authors.forename: P
authors.initials: P
authors.lastname: Héno
authors.affiliation: Service de cardiologie, hôpital d'instruction des armées Laveran, BP 60149, 13384 Marseille cedex 13, France.
authors.forename: L
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009205:Myocarditis / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Acute coronary syndrome; Acute myocarditis; Cardiac MRI; Cardiomyopathie dilatée; Dilated cardiomyopathy; IRM cardiaque; Myocardite aiguë; Syndrome coronarien aigu; Trouble du rythme ventriculaire; Ventricular arrhythmia