Zagrosek Anja, Abdel-Aty Hassan, Boyé Philipp, Wassmuth Ralf, Messroghli Daniel, Utz Wolfgang, Rudolph Andre, Bohl Steffen, Dietz Rainer, Schulz-Menger Jeanette
Franz-Volhard-Klinik, Kardiologie, Charité Campus Buch, HELIOS-Klinikum Berlin, Universitätsmedizin Berlin, Berlin, Germany.
JACC Cardiovasc Imaging. 2009 Feb;2(2):131-8. doi: 10.1016/j.jcmg.2008.09.014.
We sought to assess the value of cardiac magnetic resonance (CMR) to monitor the spectrum of myocarditis-related injuries over the course of the disease.
Myocarditis is associated with a wide range of myocardial tissue injuries, both reversible and irreversible. Differentiating these types of injuries is a clinical demand.
We studied 36 patients (31 males, age 33 +/- 14 years) hospitalized with myocarditis during the acute phase and 18 +/- 10 months thereafter. CMR was performed on 2 1.5T scanners and included the following techniques: steady-state free precession (to assess left ventricular function and volumes), T2-weighted (myocardial edema), early (global relative enhancement [gRE], reflecting increased capillary leakage) and late T1-weighted after gadolinium-DTPA injection (late gadolinium enhancement [LGE], reflecting irreversible injury).
In the acute phase, T2 ratio was elevated in 86%, gRE in 80%, and LGE was present in 63%. At follow-up, ejection fraction increased from 56 +/- 8% to 62 +/- 7% (p < 0.0001) while both T2 ratio (2.4 +/- 0.5 to 1.9 +/- 0.2; p < 0.0001) and gRE (7.6 +/- 8 to 4.4 +/- 4; p = 0.018) significantly decreased. LGE persisted in all but 1 patient in whom LGE completely resolved. No patient had simultaneous elevation of T2 and gRE during the convalescent phase, resulting in a negative predictive value of 100% to differentiate the 2 phases of the disease. The acute phase T2 ratio correlated significantly with the change of end-diastolic volume over time (beta = 0.47; p = 0.008). This relation remained significant in a stepwise regression analysis model including T2 ratio, gRE, LGE extent, baseline ejection fraction, age, and creatine kinase, in which only T2 emerged as an independent predictor of the change in end-diastolic volume.
A comprehensive CMR approach is a useful tool to monitor the reversible and irreversible myocardial tissue injuries over the course of myocarditis and to differentiate acute from healed myocarditis in patients with still-preserved ejection fraction.
我们试图评估心脏磁共振成像（CMR）在监测心肌炎相关损伤在疾病过程中的范围的价值。
心肌炎与多种心肌组织损伤相关，包括可逆性和不可逆性损伤。区分这些类型的损伤是临床需求。
我们研究了36例患者（31例男性，年龄33±14岁），他们在急性期因心肌炎住院，并在之后18±10个月进行随访。在两台1.5T扫描仪上进行CMR检查，包括以下技术：稳态自由进动序列（用于评估左心室功能和容积）、T2加权成像（检测心肌水肿）、早期（整体相对强化[gRE]，反映毛细血管渗漏增加）以及钆喷酸葡胺注射后延迟T1加权成像（延迟钆强化[LGE]，反映不可逆损伤）。
在急性期，86%的患者T2比值升高，80%的患者gRE升高，63%的患者存在LGE。随访时，射血分数从56±8%增加到62±7%（p<0.0001），而T2比值（从2.4±0.5降至1.9±0.2；p<0.0001）和gRE（从7.6±8降至4.4±4；p=0.018）均显著降低。除1例LGE完全消退的患者外，其余患者LGE均持续存在。在恢复期，没有患者同时出现T2和gRE升高，因此区分疾病两个阶段的阴性预测值为100%。急性期T2比值与舒张末期容积随时间的变化显著相关（β=0.47；p=0.008）。在一个逐步回归分析模型中，该关系仍然显著，该模型包括T2比值、gRE、LGE范围、基线射血分数、年龄和肌酸激酶，其中只有T2是舒张末期容积变化的独立预测因子。
一种全面的CMR方法是监测心肌炎病程中可逆性和不可逆性心肌组织损伤以及区分射血分数仍保留的患者急性心肌炎与愈合心肌炎的有用工具。
