Abstract 18087: First-Line Cardiac Multislice Computed Tomography for the Diagnosis of Myocarditis.
Introduction: Cardiac magnetic resonance imaging (MRI)-coupled coronary angiography is the standard approach for the diagnosis of myocarditis. Previously reported small series have shown that myocardial pictures obtained with cardiac multislice computed tomography (MSCT) are similar to those obtained by MRI. By contrast with MRI, MSCT makes also possible the visualization of the coronary arteries (CA).
Hypothesis: Therefore, we hypothesized that MSCT may be used as a first-line non-invasive approach for the diagnosis of myocarditis.
Methods: from June 03, 2005 to October 30, 2009, we performed a cardiac 16-row MSCT in 33 consecutive patients (mean age 30±9 yrs, 29 males) who were suspected of acute myocarditis based on the presence of chest pain with ST segment/T wave abnormalities, elevated troponin I, and a recent viral infection and/or a biological inflammatory syndrome. MSCT diagnosis criteria for myocarditis were defined by both normal CA and the presence of the subepicardial delayed contrast-enhancement. Coronary angiogram was performed only in case of poor quality MSCT CA imaging and/or presence of CA lesions visualized on MSCT. A history of infectious episode was present in 21 pts (63%). C reactive protein and troponin I were both elevated in all pts (mean values 49±75 mg/l and 16±18 μg/l, respectively). High quality images of CA were obtained by MSCT in 31/33 cases (94%). Coronary angiogram performed after MSCT in the 2 cases with poor quality MSCT CA images but typical images of myocarditis showed normal CA (definite myocarditis). Among the 31 pts with high quality MSCT CA imaging, 27 had normal MSCT CA with typical myocardium images of myocarditis (definite myocarditis), 1 case had no image of myocarditis but pericardial effusion at MSCT with normal CA (pericarditis) and 3 cases had typical MSCT images of subendocardial infarction with obstructive CA disease confirmed by subsequent coronary angiogram.
Conclusion: In conclusion, our data suggest that MSCT may be used as a first-line diagnostic approach in pts suspected of myocarditis avoiding the need for invasive coronary angiogram coupled with MRI.
- © 2010 by American Heart Association, Inc.