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Diagnostic and prognostic validity of different biomarkers in patients with suspected myocarditis

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Abstract

Background

Myocarditis might be associated with increased markers of myocardial injury. However, data on novel biomarkers, such as high-sensitive Troponin T (hs-TnT) or Copeptin, are lacking. This study aimed to determine the diagnostic and prognostic utility of biomarkers in patients with suspected myocarditis.

Methods

Seventy patients with clinically suspected myocarditis (age 43.4 ± 14 years, 76 % male, ejection fraction 36.9 ± 17.8) underwent endomyocardial biopsy (EMB) and were followed for 7.5 (2–21) months. At the time of EMB, blood samples to evaluate concentrations of hs-TnT, Copeptin, NT-proBNP and mid-regional pro-adrenomedullin (MR-proADM) were collected.

Results

According to EMB, 6 patients were diagnosed with acute myocarditis (AM) and 36 patients with chronic myocarditis (CM). In 28 patients, EMB revealed no myocardial inflammation (NM). Acute myocarditis was associated with the highest concentrations of hs-TnT compared to other groups (AM 262.9 pg/ml (61.4–884.2); CM 20.4 pg/ml (15.6–20.4); NM 19.5 pg/ml (13.8–50.7); p < 0.0001). No significant differences existed in the Copeptin, NT-proBNP, and MR-proADM concentrations between the groups. The concentration of hs-TnT was significantly higher in myocarditis when myocardial viral genome was detected (37.4 pg/ml (21.9–163.6) vs. 20 pg/ml (14–44.4); p = 0.042). During follow-up, only NT-proBNP in the highest quartile (>4,225 ng/ml) was predictive for cardiac death or heart transplantation (hazard ratio 9.2; 95 % confidence interval 1.7–50; p = 0.011).

Conclusions

Biopsy-proven acute and viral myocarditis is associated with elevated concentrations of hs-TnT. Elevated hs-TnT is highly suggestive of acute myocarditis, if other causes of increased myocardial necrosis markers such as myocardial infarction have been systematically excluded.

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Abbreviations

AM:

Acute myocarditis

CK:

Creatinine kinase

CM:

Chronic myocarditis

EMB:

Endomyocardial biopsy

HF:

Heart failure

Hs-TnT:

High-sensitive troponin T

LVEF:

Left ventricular ejection fraction

MRI:

Magnetic resonance imaging

MR-proADM:

Mid-regional pro-adrenomedullin

NM:

No myocardial inflammation

NT-proBNP:

N-terminal pro-B-type natriuretic peptide

ROC:

Receiver operating characteristic

References

  1. Cooper LT Jr (2009) Myocarditis. N Engl J Med 360:1526–1538

    Article  CAS  PubMed  Google Scholar 

  2. Kindermann I, Barth C, Mahfoud F et al (2012) Update on myocarditis. J Am Coll Cardiol 59:779–792

    Article  PubMed  Google Scholar 

  3. Richardson P, McKenna W, Bristow M et al (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 93:841–842

    Article  CAS  PubMed  Google Scholar 

  4. Yilmaz A, Kindermann I, Kindermann M et al (2010) Comparative evaluation of left and right ventricular endomyocardial biopsy: differences in complication rate and diagnostic performance. Circulation 122:900–909

    Article  PubMed  Google Scholar 

  5. Lauer B, Niederau C, Kuhl U et al (1997) Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 30:1354–1359

    Article  CAS  PubMed  Google Scholar 

  6. Takemura G, Fujiwara H, Takatsu Y et al (1995) Venticular expression of atrial and brain natriuretic peptides in patients with myocarditis. Int J Cardiol 52:213–222

    Article  CAS  PubMed  Google Scholar 

  7. Meissner J, Nef H, Darga J et al (2011) Endogenous stress response in Tako-Tsubo cardiomyopathy and acute myocardial infarction. Eur J Clin Invest 41:964–970

    Article  CAS  PubMed  Google Scholar 

  8. Maisel A, Mueller C, Nowak R et al (2010) Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (biomarkers in acute heart failure) trial. J Am Coll Cardiol 55:2062–2076

    Article  CAS  PubMed  Google Scholar 

  9. Kindermann I, Kindermann M, Kandolf R et al (2008) Predictors of outcome in patients with suspected myocarditis. Circulation 118:639–648

    Article  PubMed  Google Scholar 

  10. Morgenthaler NG, Struck J, Alonso C et al (2006) Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem 52:112–119

    Article  CAS  PubMed  Google Scholar 

  11. Smith SC, Ladenson JH, Mason JW et al (1997) Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation 95:163–168

    Article  CAS  PubMed  Google Scholar 

  12. Mahfoud F, Gartner B, Kindermann M et al (2011) Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J 32:897–903

    Article  CAS  PubMed  Google Scholar 

  13. Morgera T, Di Lenarda A, Dreas L et al (1992) Electrocardiography of myocarditis revisited: clinical and prognostic significance of electrocardiographic changes. Am Heart J 124:455–467

    Article  CAS  PubMed  Google Scholar 

  14. Di Bella G, Florian A, Oreto L et al (2012) Electrocardiographic findings and myocardial damage in acute myocarditis detected by cardiac magnetic resonance. Clin Res Cardiol 101:617–624

    PubMed  Google Scholar 

  15. Ukena C, Mahfoud F, Kindermann I et al (2011) Prognostic electrocardiographic parameters in patients with suspected myocarditis. Eur J Heart Fail 13:398–405

    Article  PubMed  Google Scholar 

  16. Blauwet LA, Cooper LT (2010) Myocarditis. Prog Cardiovasc Dis 52:274–288

    Article  PubMed  Google Scholar 

  17. Pauschinger M, Noutsias M, Lassner D et al (2006) Inflammation, ECG changes and pericardial effusion: whom to biopsy in suspected myocarditis? Clin Res Cardiol 95:569–583

    CAS  PubMed Central  PubMed  Google Scholar 

  18. Friedrich MG, Sechtem U, Schulz-Menger J et al (2009) Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 53:1475–1487

    Article  PubMed Central  PubMed  Google Scholar 

  19. De Cobelli F, Pieroni M, Esposito A et al (2006) Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J Am Coll Cardiol 47:1649–1654

    Article  PubMed  Google Scholar 

  20. Kuhl U, Pauschinger M, Seeberg B et al (2005) Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 112:1965–1970

    Article  PubMed  Google Scholar 

  21. Kuhl U, Lassner D, Pauschinger M et al (2008) Prevalence of erythrovirus genotypes in the myocardium of patients with dilated cardiomyopathy. J Med Virol 80:1243–1251

    Article  CAS  PubMed  Google Scholar 

  22. Corcioli F, Zakrzewska K, Rinieri A et al (2008) Tissue persistence of parvovirus B19 genotypes in asymptomatic persons. J Med Virol 80:2005–2011

    Article  CAS  PubMed  Google Scholar 

  23. Stewart GC, Lopez-Molina J, Gottumukkala RV et al (2011) Myocardial parvovirus B19 persistence: lack of association with clinicopathologic phenotype in adults with heart failure. Circ Heart Fail 4:71–78

    Article  PubMed Central  PubMed  Google Scholar 

  24. Keller T, Tzikas S, Zeller T et al (2010) Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol 55:2096–2106

    Article  CAS  PubMed  Google Scholar 

  25. Afzali D, Erren M, Pavenstadt HJ et al (2013) Impact of copeptin on diagnosis, risk stratification, and intermediate-term prognosis of acute coronary syndromes. Clin Res Cardiol 102:755–763

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

CU, FM, IK, and MB are supported by the Ministry of Science and Economy of the Saarland. CU, FM, and MB are supported by the Deutsche Forschungsgemeinschaft (KFO 196). FM is supported by Deutsche Gesellschaft für Kardiologie und Deutsche Hochdruckliga. RK is supported by the Deutsche Forschungsgemeinschaft (SFB/TR19 “Inflammatory Cardiomypathy”, B5).

Conflict of interest

CU has received speakers’ honoraria by BRAHMS/ThermoFisher, Germany.

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66421, Homburg/Saar, Germany

    Christian Ukena, Felix Mahfoud, Michael Böhm & Ingrid Kindermann

  2. Klinik für Interventionelle Kardiologie und Angiologie, CaritasKlinikum Saarbrücken St. Theresia, Saarbrücken, Germany

    Michael Kindermann

  3. Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Jürgen Geisel

  4. Klinik für Innere Medizin V (Pneumologie, Allergologie, Beatmungs und Umweltmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Philipp M. Lepper

  5. Abteilung für Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Germany

    Reinhard Kandolf

Authors
  1. Christian Ukena
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  2. Michael Kindermann
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  3. Felix Mahfoud
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  4. Jürgen Geisel
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  5. Philipp M. Lepper
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  6. Reinhard Kandolf
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  7. Michael Böhm
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  8. Ingrid Kindermann
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Corresponding author

Correspondence to Christian Ukena.

Additional information

The two authors contributed equally to the study.

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Ukena, C., Kindermann, M., Mahfoud, F. et al. Diagnostic and prognostic validity of different biomarkers in patients with suspected myocarditis. Clin Res Cardiol 103, 743–751 (2014). https://doi.org/10.1007/s00392-014-0709-z

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  • DOI: https://doi.org/10.1007/s00392-014-0709-z

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