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Role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis of acute and chronic myocarditis

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Abstract

The aetiopathogenesis of acute and chronic myocarditis is rather complex as a great variety of infectious agents can induce cardiac inflammation. Moreover, many systemic and autoimmune diseases such as sarcoidosis, giant cell myocarditis and systemic lupus erythematodes, drugs and toxins have been described as non-infectious causes of inflammatory heart disorders. Myocarditis may cause sudden death and lead to dilated cardiomyopathy. The correct and timely diagnosis of myocarditis is still a difficult clinical challenge, since the clinical spectrum of myocarditis is broad and comprises (amongst others) even those patients with no symptoms or those presenting with acute cardiogenic shock. Although endomyocardial biopsy still represents the gold standard for the diagnosis of myocarditis, new non-invasive imaging techniques such as cardiovascular magnetic resonance (CMR) imaging promise the non-invasive diagnosis of myocarditis. Considering the hallmarks of acute and chronic myocarditis (accumulation of inflammatory cells; swelling, necrosis and/or apoptosis of cardiomyocytes; increase in extracellular space and water content; myocardial remodelling with fibrotic tissue replacement), an imaging modality such as CMR that enables non-invasive detection of changes in myocardial tissue composition is highly valuable and welcome. This review will focus on the ‘clinical role’ of CMR in the diagnosis of acute and chronic myocarditis.

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Acknowledgments

A.Y. is financially supported by a grant from the Robert-Bosch-Foundation (grant-ID I1).

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Authors and Affiliations

  1. Division of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany

    Ali Yilmaz & Udo Sechtem

  2. Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK

    Vanessa Ferreira & Stefan Neubauer

  3. Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany

    Karin Klingel & Reinhard Kandolf

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  1. Ali Yilmaz
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  2. Vanessa Ferreira
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  3. Karin Klingel
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Correspondence to Ali Yilmaz.

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Yilmaz, A., Ferreira, V., Klingel, K. et al. Role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis of acute and chronic myocarditis. Heart Fail Rev 18, 747–760 (2013). https://doi.org/10.1007/s10741-012-9356-5

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