Diagnostic capabilities of cardiac magnetic resonance imaging in patients with inflammatory cardiomyopathy: Comparison of its results with endomyocardial biopsy data and clinical picture


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Abstract

AIM: To evaluate the diagnostic capabilities of cardiac magnetic resonance imaging (MRI) in patients with inflammatory cardiomyopathy (ICMP) and to compare its results with endomyocardial biopsy (EMB) data and clinical and laboratory parameters/MATERIAL AND METHODS: Cardiac MRI was performed using the "Lake Louise Criteria" in 51 patients with ICMP and a 4.1±3.4-year history of chronic heart failure (CHF). EMB was carried out in 25 patients. Their clinical state was evaluated by the results of a 6-minute walk test and by a clinical assessment scale; N-terminal pro-brain natriuretic peptide levels were estimated. All the patients received the recommended therapy for CHF/RESULTS: Myocardial areas of delayed enhancement were found in 20 (39%) patients. Myocardial edema or early contrast enhancement was not recorded in any case. An immunohistological study revealed myocardial inflammation in 12 (48%) patients. Six patients with chronic myocarditis and 4 patients without myocarditis had delayed-phase contrast enhancement areas. There was a statistically significant correlation of the contrast-enhanced myocardial volume with the frequency of single and paired ventricular premature beats (r=0.66; p=0.002 and r=0.54; p=0.01)/CONCLUSION: The patients with delayed enhancement are at high risk of ventricular tachycardia. The severity of CHF is uncorrelated with the contrast-enhanced myocardial volume. Delayed enhancement is unrelated to the activity of myocardial inflammation, as evidenced by the immunohistological study.

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Диагностические возможности магнитно-резонансной томографии сердца у больных с воспалительной кардиомиопатией: сопоставление результатов с данными эндомиокардиальной биопсии и клинической картиной. - Резюме. Цель исследования. Оценить диагностические возможности магнитно-резонансной томографии (МРТ) сердца у больных с воспалительной кардиомиопатией (ВКМП) и сопоставить полученные результаты с данными эндомиокардиальной биопсии (ЭМБ) и клинико-лабораторными параметрами. Материалы и методы. МРТ сердца с применением "Lake Louise Criteria" проведена 51 пациенту с ВКМП с длительностью хронической сердечной недостаточности (ХСН) 4,1±3,4 года. ЭМБ выполнена 25 больным. Оценку клинического состояния проводили по результатам пробы с 6-минутной ходьбой, с помощью шкалы оценки клинического состояния, определяли уровень N-концевого предшественника мозгового натрийуретического пептида. Все пациенты получали рекомендованную для лечения ХСН терапию. Результаты. У 20 (39%) больных выявлены участки с отсроченным контрастированием миокарда. Отек миокарда и раннее накопление контрастного препарата не регистрировалось ни в одном случае. Воспаление в миокарде по данным иммуногистологического исследования выявлено у 12 (48%) больных. У 6 пациентов с хроническим миокардитом и у 4 без миокардита имелись участки с накоплением контрастного препарата в отсроченную фазу. Выявлена статистически значимая корреляция объема контрастированного миокарда с частотой одиночных и парных желудочковых экстрасистол (r=0,66; p=0,002 и r=0,54; p=0,01). Заключение. У пациентов с отсроченным контрастированием имеется высокий риск развития желудочковой тахикардии. Тяжесть ХСН не коррелирует с объемом контрастированного миокарда. Наличие отсроченного контрастирования не зависит от активности воспалительного процесса по данным иммуногистологического исследования.
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