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Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis
Author(s) -
Codreanu Andrei,
Djaballah Wassila,
Angioi Michael,
Ethevenot Gérard,
Moulin Frederic,
Felblinger Jacques,
Sadoul Nicolas,
Karcher Gilles,
Aliot Etienne,
Marie Pierre Y.
Publication year - 2007
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.20897
Subject(s) - medicine , cardiology , steady state free precession imaging , myocarditis , chest pain , acute coronary syndrome , stenosis , perfusion , magnetic resonance imaging , radiology , myocardial infarction
Purpose To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis. Materials and Methods A total of 27 consecutive patients (age = 45 ± 17 years; 14 male) presenting with ACS (chest pain, positive troponin‐I) and no coronary stenosis, underwent cardiac MRI 9 ± 7 days after pain onset and 8 ± 5 months later ( N = 19). Steady‐state free‐precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion‐recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi‐gated‐single photon emission CT (SPECT) was also systematically performed. Results Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C‐reactive protein (CRP) levels (38 ± 32 vs. 14 ± 24 mg/mL; P = 0.04), lower Framingham cardiovascular risk (3 ± 3% vs. 9 ± 5%; P < 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P = 0.01), higher left ventricular (LV) end‐diastolic volume (77 ± 16 vs. 64 ± 10 mL/m 2 ; P = 0.02), and higher regression of DCE areas at follow‐up (−65 ± 17% vs. −18 ± 23%; P = 0.002). Conclusion DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis. J. Magn. Reson. Imaging 2007;25:957–964. © 2007 Wiley‐Liss, Inc.