Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
JACC Cardiovasc Imaging. 2012 May;5(5):513-24. doi: 10.1016/j.jcmg.2011.11.022.
The goal of this study was to assess the diagnostic performance of cardiac magnetic resonance (CMR) compared with endomyocardial biopsy in patients with suspected acute myocarditis (AMC) and chronic myocarditis (CMC).
Several studies have reported an encouraging diagnostic performance of CMR in myocarditis. However, the comparison of CMR with clinical data only and the use of preselected patient populations are important limitations of the majority of these reports.
One hundred thirty-two consecutive patients with suspected AMC (defined by symptoms ≤ 14 days; n = 70) and CMC (defined by symptoms >14 days; n = 62) were included. Patients underwent cardiac catheterization with left ventricular endomyocardial biopsy and CMR, including T(2)-weighted imaging for assessment of edema, T(1)-weighted imaging before and after contrast administration for evaluation of hyperemia, and assessment of late gadolinium enhancement. CMR results were considered to be consistent with the diagnosis of myocarditis if 2 of 3 CMR techniques were positive.
Within the total population, myocarditis was the most common diagnosis on endomyocardial biopsy analysis (62.9%). Viral genomes were detected in 30.3% (40 of 132) of patients within the total patient population and significantly more often in patients with AMC than CMC (40.0% vs. 19.4%; p = 0.013). For the overall cohort of patients with either suspected AMC or CMC, the diagnostic sensitivity, specificity, and accuracy of CMR were 76%, 54%, and 68%, respectively. The best diagnostic performance was observed in patients with suspected AMC (sensitivity, 81%; specificity, 71%; and accuracy, 79%). In contrast, diagnostic performance of CMR in suspected CMC was found to be unsatisfactory (sensitivity, 63%; specificity, 40%; and accuracy, 52%).
The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management.
本研究旨在评估心脏磁共振（CMR）与心内膜心肌活检在疑似急性心肌炎（AMC）和慢性心肌炎（CMC）患者中的诊断性能。
多项研究报告称 CMR 在心肌炎中的诊断性能令人鼓舞。然而，这些报告中的大多数都存在重要的局限性，即仅将 CMR 与临床数据进行比较，以及使用预先选择的患者人群。
纳入 132 例连续疑似 AMC（定义为症状≤14 天；n=70）和 CMC（定义为症状>14 天；n=62）患者。患者接受了心脏导管插入术和左心室心内膜心肌活检以及 CMR，包括 T2 加权成像评估水肿，钆增强前后 T1 加权成像评估充血，以及晚期钆增强评估。如果 3 种 CMR 技术中有 2 种结果一致，则认为 CMR 结果与心肌炎的诊断相符。
在总人群中，心内膜心肌活检分析的最常见诊断是心肌炎（62.9%）。在总患者人群中，30.3%（40/132）的患者检测到病毒基因组，并且 AMC 患者中的病毒基因组检出率显著高于 CMC 患者（40.0% vs. 19.4%；p=0.013）。对于同时患有疑似 AMC 或 CMC 的患者总体队列，CMR 的诊断灵敏度、特异度和准确性分别为 76%、54%和 68%。在疑似 AMC 患者中观察到最佳的诊断性能（灵敏度为 81%，特异度为 71%，准确性为 79%）。相比之下，疑似 CMC 患者中 CMR 的诊断性能不理想（灵敏度为 63%，特异度为 40%，准确性为 52%）。
本研究结果强调了 CMR 在疑似 AMC 患者中的有用性。相比之下，CMR 在疑似 CMC 患者中的诊断性能可能不足以指导临床管理。
