Brendel Jan M, Klingel Karin, Gräni Christoph, Blankstein Ron, Kübler Jens, Hagen Florian, Gawaz Meinrad, Nikolaou Konstantin, Krumm Patrick, Greulich Simon
Department of Diagnostic and Interventional Radiology, Tübingen University Hospital, University of Tübingen, Tübingen, Germany.
Cardiopathology, Institute for Pathology, Tübingen University Hospital, University of Tübingen, Tübingen, Germany.
JACC Cardiovasc Imaging. 2024 Oct;17(10):1182-1195. doi: 10.1016/j.jcmg.2024.06.009. Epub 2024 Aug 7.
Detecting ongoing inflammation in myocarditis patients has prognostic relevance, but there are limited data on the detection of chronic myocarditis and its differentiation from healed myocarditis.
This study sought to assess the performance of cardiac magnetic resonance (CMR) for the detection of ongoing inflammation and the discrimination of chronic myocarditis from healed myocarditis.
Consecutive patients with persistent symptoms (>30 days) suggestive of myocarditis were prospectively enrolled from a single tertiary center. All patients underwent a multiparametric 1.5-T CMR protocol including biventricular strain, T/T mapping, and late gadolinium enhancement (LGE). Endomyocardial biopsy was chosen for the reference standard diagnosis.
Among 452 consecutive patients, 103 (median age: 50 years; 66 men) had evaluable CMR and cardiopathologic reference diagnosis: 53 (51%) with chronic lymphocytic myocarditis and 50 (49%) with healed myocarditis. T mapping as a single parameter showed the best accuracy in detecting chronic myocarditis, if abnormal in ≥3 segments (92%; 95% CI: 85-97), and provided the best discrimination from healed myocarditis, as defined by the area under the receiver-operating characteristic curve (0.87 [95% CI: 0.79-0.93]; P < 0.001), followed by radial peak systolic strain rate of the left ventricle (0.86) and the right ventricle (0.84); T mapping (0.64), extracellular volume fraction (0.62), and LGE (0.57). Specificity increased when T mapping was combined with elevation of either troponin or C-reactive protein.
A multiparametric CMR protocol allows detection of ongoing myocardial inflammation and discrimination of chronic myocarditis from healed myocarditis, with segmental T mapping and biventricular strain analysis showing higher diagnostic accuracy compared with T mapping, extracellular volume fraction, and LGE. The use of biomarkers (troponin or C-reactive protein) may improve specificity.
检测心肌炎患者的持续性炎症具有预后意义，但关于慢性心肌炎的检测及其与愈合性心肌炎鉴别的数据有限。
本研究旨在评估心脏磁共振成像（CMR）检测持续性炎症以及区分慢性心肌炎与愈合性心肌炎的性能。
从一家三级中心前瞻性纳入连续出现提示心肌炎的持续性症状（>30天）的患者。所有患者均接受了包括双心室应变、T2/T1映射和延迟钆增强（LGE）的多参数1.5-T CMR检查。选择心内膜心肌活检作为参考标准诊断。
在452例连续患者中，103例（中位年龄：50岁；66例男性）有可评估的CMR和心脏病理参考诊断：53例（51%）为慢性淋巴细胞性心肌炎，50例（49%）为愈合性心肌炎。T2映射作为单一参数，在检测慢性心肌炎时，如果≥3个节段异常，显示出最佳准确性（92%；95%CI：85-97），并能最好地区分愈合性心肌炎，根据受试者工作特征曲线下面积定义（0.87[95%CI：0.79-0.93]；P<0.001），其次是左心室（0.86）和右心室（0.84）的径向峰值收缩应变率；T2映射（0.64）、细胞外容积分数（0.62）和LGE（0.57）。当T2映射与肌钙蛋白或C反应蛋白升高相结合时，特异性增加。
多参数CMR检查能够检测持续性心肌炎症，并区分慢性心肌炎与愈合性心肌炎，节段性T2映射和双心室应变分析与T2映射、细胞外容积分数和LGE相比，显示出更高的诊断准确性。使用生物标志物（肌钙蛋白或C反应蛋白）可能会提高特异性。
