Multiparametric Cardiac Magnetic Resonance Imaging to Discriminate Endomyocardial Biopsy-Proven Chronic Myocarditis From Healed Myocarditis

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular imaging Pub Date : 2024-10-01 DOI:10.1016/j.jcmg.2024.06.009

Jan M. Brendel MD , Karin Klingel MD , Christoph Gräni MD, PhD , Ron Blankstein MD , Jens Kübler MD , Florian Hagen MD , Meinrad Gawaz MD , Konstantin Nikolaou MD , Patrick Krumm MD , Simon Greulich MD

{"title":"Multiparametric Cardiac Magnetic Resonance Imaging to Discriminate Endomyocardial Biopsy-Proven Chronic Myocarditis From Healed Myocarditis","authors":"Jan M. Brendel MD , Karin Klingel MD , Christoph Gräni MD, PhD , Ron Blankstein MD , Jens Kübler MD , Florian Hagen MD , Meinrad Gawaz MD , Konstantin Nikolaou MD , Patrick Krumm MD , Simon Greulich MD","doi":"10.1016/j.jcmg.2024.06.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Detecting ongoing inflammation in myocarditis patients has prognostic relevance, but there are limited data on the detection of chronic myocarditis and its differentiation from healed myocarditis.</div></div><div><h3>Objectives</h3><div>This study sought to assess the performance of cardiac magnetic resonance (CMR) for the detection of ongoing inflammation and the discrimination of chronic myocarditis from healed myocarditis.</div></div><div><h3>Methods</h3><div>Consecutive patients with persistent symptoms (>30 days) suggestive of myocarditis were prospectively enrolled from a single tertiary center. All patients underwent a multiparametric 1.5-T CMR protocol including biventricular strain, T<sub>1</sub>/T<sub>2</sub> mapping, and late gadolinium enhancement (LGE). Endomyocardial biopsy was chosen for the reference standard diagnosis.</div></div><div><h3>Results</h3><div>Among 452 consecutive patients, 103 (median age: 50 years; 66 men) had evaluable CMR and cardiopathologic reference diagnosis: 53 (51%) with chronic lymphocytic myocarditis and 50 (49%) with healed myocarditis. T<sub>2</sub> mapping as a single parameter showed the best accuracy in detecting chronic myocarditis, if abnormal in ≥3 segments (92%; 95% CI: 85-97), and provided the best discrimination from healed myocarditis, as defined by the area under the receiver-operating characteristic curve (0.87 [95% CI: 0.79-0.93]; <em>P <</em> 0.001), followed by radial peak systolic strain rate of the left ventricle (0.86) and the right ventricle (0.84); T<sub>1</sub> mapping (0.64), extracellular volume fraction (0.62), and LGE (0.57). Specificity increased when T<sub>2</sub> mapping was combined with elevation of either troponin or C-reactive protein.</div></div><div><h3>Conclusions</h3><div>A multiparametric CMR protocol allows detection of ongoing myocardial inflammation and discrimination of chronic myocarditis from healed myocarditis, with segmental T<sub>2</sub> mapping and biventricular strain analysis showing higher diagnostic accuracy compared with T<sub>1</sub> mapping, extracellular volume fraction, and LGE. The use of biomarkers (troponin or C-reactive protein) may improve specificity.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":"17 10","pages":"Pages 1182-1195"},"PeriodicalIF":12.8000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular imaging","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936878X24002444","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Detecting ongoing inflammation in myocarditis patients has prognostic relevance, but there are limited data on the detection of chronic myocarditis and its differentiation from healed myocarditis.

Objectives

This study sought to assess the performance of cardiac magnetic resonance (CMR) for the detection of ongoing inflammation and the discrimination of chronic myocarditis from healed myocarditis.

Methods

Consecutive patients with persistent symptoms (>30 days) suggestive of myocarditis were prospectively enrolled from a single tertiary center. All patients underwent a multiparametric 1.5-T CMR protocol including biventricular strain, T₁/T₂ mapping, and late gadolinium enhancement (LGE). Endomyocardial biopsy was chosen for the reference standard diagnosis.

Results

Among 452 consecutive patients, 103 (median age: 50 years; 66 men) had evaluable CMR and cardiopathologic reference diagnosis: 53 (51%) with chronic lymphocytic myocarditis and 50 (49%) with healed myocarditis. T₂ mapping as a single parameter showed the best accuracy in detecting chronic myocarditis, if abnormal in ≥3 segments (92%; 95% CI: 85-97), and provided the best discrimination from healed myocarditis, as defined by the area under the receiver-operating characteristic curve (0.87 [95% CI: 0.79-0.93]; P < 0.001), followed by radial peak systolic strain rate of the left ventricle (0.86) and the right ventricle (0.84); T₁ mapping (0.64), extracellular volume fraction (0.62), and LGE (0.57). Specificity increased when T₂ mapping was combined with elevation of either troponin or C-reactive protein.

Conclusions

A multiparametric CMR protocol allows detection of ongoing myocardial inflammation and discrimination of chronic myocarditis from healed myocarditis, with segmental T₂ mapping and biventricular strain analysis showing higher diagnostic accuracy compared with T₁ mapping, extracellular volume fraction, and LGE. The use of biomarkers (troponin or C-reactive protein) may improve specificity.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

多参数心脏磁共振成像用于鉴别心内膜活检证实的慢性心肌炎和痊愈的心肌炎

背景：检测心肌炎患者的持续炎症与预后有关：检测心肌炎患者的持续炎症对预后有重要意义，但检测慢性心肌炎并将其与痊愈的心肌炎区分开来的数据有限：本研究旨在评估心脏磁共振（CMR）在检测持续性炎症和区分慢性心肌炎与痊愈的心肌炎方面的性能：方法：一家三级医疗中心前瞻性地招募了连续出现持续症状（超过 30 天）并提示患有心肌炎的患者。所有患者均接受了多参数 1.5-T CMR 检查，包括双心室应变、T1/T2 映射和晚期钆增强（LGE）。心内膜活检是诊断的参考标准：在 452 名连续患者中，103 人（中位年龄：50 岁；66 名男性）具有可评估的 CMR 和心脏病理参考诊断：53 人（51%）患有慢性淋巴细胞性心肌炎，50 人（49%）患有痊愈性心肌炎。如果在≥3个节段中出现异常，T2映射作为单一参数在检测慢性心肌炎方面显示出最佳准确性（92%；95% CI：85-97），并且与痊愈的心肌炎具有最佳区分度，这是由接收者工作特征曲线下面积（0.87[95%CI：0.79-0.93]；P < 0.001），其次是左心室（0.86）和右心室（0.84）的径向收缩应变峰值率；T1 映像（0.64）、细胞外容积分数（0.62）和 LGE（0.57）。当 T2 图谱与肌钙蛋白或 C 反应蛋白升高相结合时，特异性会增加：结论：多参数 CMR 方案可检测正在进行的心肌炎症并区分慢性心肌炎和痊愈的心肌炎，与 T1 图谱、细胞外容积分数和 LGE 相比，节段 T2 图谱和双心室应变分析显示出更高的诊断准确性。使用生物标记物（肌钙蛋白或 C 反应蛋白）可提高特异性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.