Abstract 14740: Cardiac Magnetic Resonance Imaging Or Endomyocardial Biopsy For The Diagnosis Of Myocarditis And Viral Heart Disease
Purpose: Cardiac MRI(CMRI) has been proposed as non-invasive diagnostic standard of myocarditis. However, it has not been systematically validated against the undisputed histological standard of inflammation, which is endomyocardial biopsy(EMB).
Patients (pts): CMRI and EMB were compared in 343 consecutive pts with clinically suspected inflammatory dilated cardiomyopathy (mean age 51.1 y, 217 m, 126 f).
Methods: CMRI criteria for (peri)myocarditis were the 3 Lake Louise Criteria 1) late gadolinium enhancement(LGE), 2) T1 gRE=gE(myocardium)/gE (skelettal muscle)>4.3) T2-edema signal intensity (SI) comparing heart and skelettal muscle >1.9 and 4) pericardial effusion (PE). Nine EMBs from the left ventricle were analysed for >14 cells/mm² (WHF-criteria) and for the genomes of entero-, adeno-, cytomegalo-, Ebstein Barr, Influenza-, Parvo B19-, herpes humanus 6, herpes simplex virus, chlamydia pneumoniae, borrelia Burgdorferi in the EMB and for HIV and Hepatitis C in serum. The number of positive items (1 to 4) by CMRI was compared to the presence of inflammation and/or virus in the respective EMB (EMB1=all inflammation; EMB 2 =inflammation+virus, EMB 3: inflammation without virus).
Results: EMB 1 was positive in 60 pts, but only 3 pts demonstrated all 4, 14 pts 3, 11 pts 2 and 24 pts 1 CMRI myocarditis criteria. EMB 2 (I+v)) was observed in 25 pts, but only 2 pts demonstrated all 4, 6 pts 3, 8 pts 2 and 8 pts 1 CMRI criterium of inflammation. Inflammation in EMB without virus(EMB 3) was observed in 35 pts, but positive for 4 CMRI-criteria was only 1 pt, 3 MRI-criteria were positive in 8 pts, 2 criteria in 3 pts, and one criterium in 16 pts. Viral persistence without any inflammation did not show feasible correlation s CMRI.
Conclusions: CMRI according to the Lake Louise criteria gives limited, but helpful information for inflammation in the myocardium. It is unable to correlate with no inflammation and viral persistence alone. EMB remains the definite standard in the diagnosis of viral and inflammatory cardiomyopathy.
- © 2011 by American Heart Association, Inc.