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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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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References

  1. Cooper L.T., Baughman K.L., Feldman A.M. et al. The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. J Am Coll Card 2007; 50 (19): 1914-1931.
  2. Deckers J.W., Hare J.M., Baughman K.M. Complications of transvenous right ventricular endomyocardial biopsy in adult patients with cardiomyopathy: a seven-year survey of 546 consecutive diagnostic procedures in a tertiary referral center. J Am Coll Card 1992; 19: 43-47.
  3. Shirani J., Freant L.J., Roberts W.C. Gross and semiquantitative histologic findings in mononuclear cell myocarditis causing sudden death, and implications for endomyocardial biopsy. Am J Cardiol 1993; 72: 952-957.
  4. Kishimoto C., Hiraoka Y. Clinical and experimental studies in myocarditis. Curr Opin Cardiol 1994; 9: 349-356.
  5. Abdel-Aty H., Simonetti O., Friedrich M.G. T2-weighted cardiovascular magnetic resonance imaging. J Magn Reson Imaging 2007; 26: 452-459.
  6. 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.
  7. Cocker M.S., Abdel-Aty H., Strohm O., Friedrich M.G. Age and gender effects on the extent of myocardial involvement in acute myocarditis: a cardiovascular magnetic resonance study. Heart 2009; 95 (23): 1925-1930.
  8. Friedrich M.G., Strohm O., Schulz-Menger J. et al. Contrastmediaenhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation 1998; 97: 1802-1809.
  9. Kim R.J., Judd R.M., Chen E.L. et al. Relationship of elevated 23Na magnetic resonance image intensity to infarct size after acute reperfused myocardial infarction. Circulation 1999; 100: 185-192.
  10. Thomson L.E., Kim R.J., Judd R.M. Magnetic resonance imaging for the assessment of myocardial viability. J Magn Reson Imaging 2004; 19: 771-788.
  11. Friedrich M.G., Sechtem U., Schulz-Menger J. et al. Cardiovascular Magnetic Resonance in Myocarditis: A JACC White Paper 2009; 53 (17): 1475-1487.
  12. Mahrholdt H., Wagner A., Judd R.M. et al. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 2005; 26: 1461-1474.
  13. 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.
  14. Richardson P., McKenna W., Bristow M. et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation 1996; 93 (5): 841-842.
  15. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Сердеч недостат 2010; 1: 3-62.
  16. Cerqueira M.D., Weissman N.J., Dilsizian V. et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539-542.
  17. Aretz H.T., Billingham M.E., Edwards W.D. et al. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1987; 1: 3-14.
  18. Maisch B., Richter A., Sandmoller A. et al. BMBF-Heart Failure Network: Inflammatory dilated cardiomyopathy (DCMI). Herz 2005; 30: 535-544.
  19. Gauntt C., Tracy C., Chapman N. et al. Coxsackie virus-induced chronic myocarditis in murine models. Eur Heart J 1995; 16 (suppl O): 56-58.
  20. Voigt A., Elgeti T., Durmus T. et al. Cardiac Magnetic Resonance Imaging in Dilated Cardiomyopathy in Adults - Towards Identification of Myocardial Inflammation. Eur Radiol 2011; 21 (5): 925-935.
  21. Bohl S., Wassmuth R., Abdel-Aty H. et al. Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease. Int J Cardiovasc Imaging 2008; 24: 597-607.
  22. Bruder O., Schneider S., Nothnagel D., Dill T. et al. EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase. J Am Coll Cardiol 2009; 54: 1457-1466.
  23. Mahrholdt H., Wagner A., Deluigi C.C. et al. Presentation, patterns of myocardial damage and clinical course of viral myocarditis. Circulation 2006; 114: 1581-1590.
  24. De Cobelli F., Pieroni M., Esposito A. et al. Delayed gadoliniumenhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J Am Coll Cardiol 2006; 47: 1649-1654.
  25. Stensaeth K.Y., Hoffmann P., Fossum E. et al. Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis. Int J Cardiovasc Imaging 2011; 28: 327-337.
  26. Cummings K.W., Bhalla S., Javidan-Nejad C. et al. A pattern-based approach to assessment of delayed enhancement in nonischemic cardiomyopathy at MR imaging. Radiographics 2009; 29: 89-103.
  27. McCrohon J.A., Moon J.C., Prasad S.K. et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 2003; 108: 54-59.
  28. Mahrholdt H., Goedecke C., Wagner A. et al. CMR assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 1250-1258.
  29. Varghese A., Davies S., Pennell D.J. Diagnosis of myocarditis by CMR. Heart 2005; 91: 567.
  30. Shirani J., Freant L.J., Roberts W.C. Gross and semiquantitative histologic findings in mononuclear cell myocarditis causing sudden death, and implications for endomyocardial biopsy. Am J Cardiol 1993; 72: 952-957.
  31. Assomull R.G., Prasad S.K., Lyne J. et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 2006; 48: 1977-1985.

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