Current Cardiology Reports

, Volume 12, Issue 1, pp 82–89

Cardiovascular Magnetic Resonance of Myocarditis

Article

Abstract

Within the past decade, cardiovascular magnetic resonance (CMR) imaging has led to unprecedented growth in our understanding of myocarditis. From what began as a diagnostic tool for assessing ventricular function, CMR has transitioned into visualizing changes that occur in myocardial tissue during inflammation, including edema, hyperemia/inflammation, and fibrosis. In terms of research applications, the entire spectrum ranging from subclinical to fulminant myocarditis can be visualized, as well as unmasking myocarditis from other cardiomyopathies. The impact of CMR in clinical applications is best exemplified by recent findings demonstrating that CMR is a leading diagnostic tool and may perhaps even be the method of choice for establishing a diagnosis of myocarditis in Germany. With the advent of an International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis and large-scale multicenter registries on CMR-based visualization of myocarditis, further advances aimed at improving clinical decision making and guiding patient therapy are expected.

Keywords

Cardiovascular magnetic resonance Myocarditis Tissue characterization Myocardial inflammation Myocardial fibrosis 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Wozakowska-Kaplon B, Szymczyk R, Bakowski D, et al.: Myocarditis—clinical course and 2-year outcome in 32 patients. Kardiol Pol 2009, 67:642–648.PubMedGoogle Scholar
  2. 2.
    •• Cooper LT Jr: Myocarditis. N Engl J Med 2009, 360:1526–1538. This is a recent, comprehensive review of the pathogenesis, diagnosis, and treatment of myocarditis.Google Scholar
  3. 3.
    Moon JC, Sheppard M, Reed E, et al.: The histological basis of late gadolinium enhancement cardiovascular magnetic resonance in a patient with Anderson-Fabry disease. J Cardiovasc Magn Reson 2006, 8:479–482.CrossRefPubMedGoogle Scholar
  4. 4.
    Pieroni M, Dello Russo A, Marzo F, et al.: High prevalence of myocarditis mimicking arrhythmogenic right ventricular cardiomyopathy differential diagnosis by electroanatomic mapping-guided endomyocardial biopsy. J Am Coll Cardiol 2009, 53:681–689.CrossRefPubMedGoogle Scholar
  5. 5.
    Wadhwa D, Fallah-Rad N, Grenier D, et al.: Trastuzumab mediated cardiotoxicity in the setting of adjuvant chemotherapy for breast cancer: a retrospective study. Breast Cancer Res Treat 2009, 117:357–364.CrossRefPubMedGoogle Scholar
  6. 6.
    Eitel I, Lucke C, Grothoff M, et al.: Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging. Eur Radiol 2009 Aug 25 (Epub ahead of print).Google Scholar
  7. 7.
    Abdel-Aty H, Cocker M, Friedrich MG: Myocardial edema is a feature of Tako-Tsubo cardiomyopathy and is related to the severity of systolic dysfunction: insights from T2-weighted cardiovascular magnetic resonance. Int J Cardiol 2009, 132:291–293.CrossRefPubMedGoogle Scholar
  8. 8.
    Cannan C, Weeks S, Strohm O, et al.: CMR features of peri-partum cardiomyopathy. Paper presented at the Proceedings of the 13th Annual Scientific Sessions of the Society for Cardiovascular Magnetic Resonance. Phoenix, AZ; January 21–24, 2010.Google Scholar
  9. 9.
    Mouquet F, Lions C, de Groote P, et al.: Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging. Eur Radiol 2008, 18:2765–2769.CrossRefPubMedGoogle Scholar
  10. 10.
    Aretz HT, Billingham ME, Edwards WD, et al.: Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol 1987, 1:3–14.PubMedGoogle Scholar
  11. 11.
    Baughman KL: Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006, 113:593–595.CrossRefPubMedGoogle Scholar
  12. 12.
    Pauschinger M, Chandrasekharan K, Noutsias M, et al.: Viral heart disease: molecular diagnosis, clinical prognosis, and treatment strategies. Med Microbiol Immunol 2004, 193:65–69.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Friedrich MG, Sechtem U, Schulz-Menger J, et al.: Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol 2009, 53:1475–1487. This paper discusses the recommendations of the International Consensus Group on CMR in Myocarditis on indications, protocols, evaluation (Lake Louise criteria), and reporting of CMR in acute myocarditis, including a detailed description of protocol details for scanning.Google Scholar
  14. 14.
    Skouri HN, Dec GW, Friedrich MG, et al.: Noninvasive imaging in myocarditis. J Am Coll Cardiol 2006, 48:2085–2093.CrossRefPubMedGoogle Scholar
  15. 15.
    Cihakova D, Rose NR: Pathogenesis of myocarditis and dilated cardiomyopathy. Adv Immunol 2008, 99:95–114.CrossRefPubMedGoogle Scholar
  16. 16.
    Winlaw DS, Smythe GA, Keogh AM, et al.: Increased nitric oxide production in heart failure. Lancet 1994, 344:373–374.CrossRefPubMedGoogle Scholar
  17. 17.
    Badorff C, Fichtlscherer B, Rhoads RE, et al.: Nitric oxide inhibits dystrophin proteolysis by coxsackieviral protease 2A through S-nitrosylation: a protective mechanism against enteroviral cardiomyopathy. Circulation 2000, 102:2276–2281.PubMedGoogle Scholar
  18. 18.
    Reed RK, Liden A, Rubin K: Edema and fluid dynamics in connective tissue remodelling. J Mol Cell Cardiol 2009 Jul 9 (Epub ahead of print).Google Scholar
  19. 19.
    • Abdel-Aty H, Simonetti O, Friedrich MG: T2-weighted cardiovascular magnetic resonance imaging. J Magn Reson Imaging 2007, 26:452–459. This is a review of the technical and clinical utility of T2-weighted imaging for assessing myocardial edema.Google Scholar
  20. 20.
    Abdel-Aty H, Boye P, Zagrosek A, et al.: Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol 2005, 45:1815–1822.CrossRefPubMedGoogle Scholar
  21. 21.
    Cocker MS, Abdel-Aty H, Strohm O, et al.: Age and gender effects on the extent of myocardial involvement in acute myocarditis: a Cardiovascular Magnetic Resonance (CMR) Study. Heart 2009 Aug 25 (Epub ahead of print).Google Scholar
  22. 22.
    Cocker MS, Strohm O, Green J, et al.: Enhanced detection of myocardial edema with spectrally selective inversion recovery-prepared T2-weighted imaging. Paper presented at the Proceedings of the 16th Annual Scientific Sessions of the International Society of Magnetic Resonance in Medicine. Toronto, Canada; May 3–9, 2008.Google Scholar
  23. 23.
    Friedrich MG, Strohm O, Schulz-Menger J, et al.: Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation 1998, 97:1802–1809.PubMedGoogle Scholar
  24. 24.
    Gutberlet M, Spors B, Thoma T, et al.: Suspected chronic myocarditis at cardiac MR: diagnostic accuracy and association with immunohistologically detected inflammation and viral persistence. Radiology 2008, 246:401–409.CrossRefPubMedGoogle Scholar
  25. 25.
    Wagner A, Schulz-Menger J, Dietz R, et al.: Long-term follow-up of patients paragraph sign with acute myocarditis by magnetic resonance imaging. MAGMA 2003, 16:17–20.CrossRefPubMedGoogle Scholar
  26. 26.
    Kuhl U, Pauschinger M, Seeberg B, et al.: Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005, 112:1965–1970.CrossRefPubMedGoogle Scholar
  27. 27.
    Mahrholdt H, Goedecke C, Wagner A, et al.: Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004, 109:1250–1258.CrossRefPubMedGoogle Scholar
  28. 28.
    Thomson LE, Kim RJ, Judd RM: Magnetic resonance imaging for the assessment of myocardial viability. J Magn Reson Imaging 2004, 19:771–788.CrossRefPubMedGoogle Scholar
  29. 29.
    Wagner A, Mahrholdt H, Thomson L, et al.: Effects of time, dose, and inversion time for acute myocardial infarct size measurements based on magnetic resonance imaging-delayed contrast enhancement. J Am Coll Cardiol 2006, 47:2027–2033.CrossRefPubMedGoogle Scholar
  30. 30.
    • Iles L, Pfluger H, Phrommintikul A, et al.: Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol 2008, 52:1574–1580. This is the first publication on the use of post-contrast T1 mapping for detecting diffuse myocardial fibrosis in patients with heart failure.Google Scholar
  31. 31.
    Ison MG, Campbell V, Rembold C, et al.: Cardiac findings during uncomplicated acute influenza in ambulatory adults. Clin Infect Dis 2005, 40:415–422.CrossRefPubMedGoogle Scholar
  32. 32.
    Kaji M, Kuno H, Turu T, et al.: Elevated serum myosin light chain I in influenza patients. Intern Med 2001, 40:594–597.CrossRefPubMedGoogle Scholar
  33. 33.
    Whitton JL, Feuer R: Myocarditis, microbes, and autoimmunity. Autoimmunity 2004, 37:375–386.CrossRefPubMedGoogle Scholar
  34. 34.
    Jeserich M, Olschewski M, Bley T, et al.: Cardiac involvement after respiratory tract viral infection—detection by cardiac magnetic resonance. J Comput Assist Tomogr 2009, 33:15–19.CrossRefPubMedGoogle Scholar
  35. 35.
    Kyto V, Saraste A, Voipio-Pulkki LM, et al.: Incidence of fatal myocarditis: a population-based study in Finland. Am J Epidemiol 2007, 165:570–574.CrossRefPubMedGoogle Scholar
  36. 36.
    Diaz FJ, Loewe C, Jackson A: Death caused by myocarditis in Wayne County, Michigan: a 9-year retrospective study. Am J Forensic Med Pathol 2006, 27:300–303.CrossRefPubMedGoogle Scholar
  37. 37.
    Bello D, Fieno DS, Kim RJ, et al.: Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol 2005, 45:1104–1108.CrossRefPubMedGoogle Scholar
  38. 38.
    Morimoto S, Kato S, Hiramitsu S, et al.: Role of myocardial interstitial edema in conduction disturbances in acute myocarditis. Heart Vessels 2006, 21:356–360.CrossRefPubMedGoogle Scholar
  39. 39.
    Mahrholdt H, Wagner A, Deluigi CC, et al.: Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006, 114:1581–1590.CrossRefPubMedGoogle Scholar
  40. 40.
    Wu KC, Weiss RG, Thiemann DR, et al.: Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy. J Am Coll Cardiol 2008, 51:2414–2421.CrossRefPubMedGoogle Scholar
  41. 41.
    Zagrosek A, Abdel-Aty H, Boye P, et al.: Cardiac magnetic resonance monitors reversible and irreversible myocardial injury in myocarditis. JACC Cardiovasc Imaging 2009, 2:131–138.CrossRefPubMedGoogle Scholar
  42. 42.
    •• Bruder O, Schneider S, Nothnagel D, et al.: EuroCMR (European Cardiovascular Magnetic Resonance) registry results of the German pilot phase. J Am Coll Cardiol 2009, 54:1457–1466. This publication reports findings from one of the largest registries that sought to assess the clinical indications for which patients were sent for CMR and highlights the clinical impact of CMR on myocarditis, which was found to be the most frequent indication for referrals.Google Scholar
  43. 43.
    Butler CR, Thompson R, Haykowsky M, et al.: Cardiovascular magnetic resonance in the diagnosis of acute heart transplant rejection: a review. J Cardiovasc Magn Reson 2009, 11:7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Stephenson Cardiovascular Magnetic Resonance Centre, Foothills HospitalUniversity of CalgaryCalgaryCanada

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