Myocarditis - Noninvasive Diagnosis

2/12/2003

Question: Are there reliable noninvasive techniques that can be used in the diagnosis of myocarditis?

 [Note: Dallas Criteria for diagnosis of myocarditis published as #24 in this listing]

Link Directly to Fulltext article in Ovid

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Unique Identifier:11070105

Authors: Feldman AM. McNamara D.

Institution: Cardiovascular Institute, University of Pittsburgh School of Medicine, USA. feldmanam@msx.upmc.edu

Title: Myocarditis.[comment]. [Review] [149 refs]

Source: New England Journal of Medicine. 343(19):1388-98, 2000 Nov 9.

 Link Directly to Fulltext Article at Science Direct

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Unique Identifier:9350939

Authors: Lauer B. Niederau C. Kuhl U. Schannwell M. Pauschinger M. Strauer BE. Schultheiss HP.

Institution: Herzzentrum Leipzig, Universitatsklinik fur Kardiologie, Leipzig, Germany. e.und.b.lauer@t-online.de

Title: Cardiac troponin T in patients with clinically suspected myocarditis.

Source: Journal of the American College of Cardiology. 30(5):1354-9, 1997 Nov 1.

Abstract: OBJECTIVES: The present study investigated whether myocyte injury can be assessed sensitively by measurement of serum levels of cardiac troponin T (cTnT) in patients with clinically suspected myocarditis and whether cTnT levels may predict the results of histologic and immunohistologic analysis of endomyocardial biopsy specimens. BACKGROUND: Conventionally used laboratory variables often fail to show myocyte injury in patients with clinically suspected myocarditis, possibly because of a low extent of myocardial injury in these patients. Sensitive variables for myocyte injury have not yet been investigated. METHODS: Eighty patients with clinically suspected myocarditis were screened for creatine kinase (CK) activity, MB isoform of CK (CK-MB) activity and cTnT. Endomyocardial biopsy specimens were examined histologically and immunohistologically. RESULTS: cTnT was elevated in 28 of 80 patients with clinically suspected myocarditis, CK in 4 and CK-MB in 1. Histologic analysis alone of the endomyocardial biopsy specimen revealed evidence of myocarditis in only five patients, all with elevated cTnT levels. Twenty-three of 28 patients with elevated cTnT levels had histologically negative findings for myocarditis. Additional immunohistologic analysis revealed evidence of myocarditis in 26 (93%) of 28 patients with elevated cTnT levels and in 23 (44%) of 52 patients with normal cTnT levels. Mean cTnT levels were higher in patients with myocarditis proved histologically or immunohistologically, or both, than in patients without myocarditis (0.59 +/- 1.68 vs. 0.04 +/- 0.05, p < 0.001). CONCLUSIONS: Measurement of serum levels of cTnT provides evidence of myocyte injury in patients with clinically suspected myocarditis more sensitively than does conventional determination of cardiac enzyme levels. Myocardial cell damage may be present even in the absence of histologic signs of myocarditis. Additional immunohistologic analysis often shows lymphocytic infiltrates in these patients. Elevated levels of cTnT are highly predictive for myocarditis in this group. CAS Registry/EC Number 0 (Biological Markers). 0 (Isoenzymes). 0 (Troponin). 0 (Troponin T). EC 2-7-3-2 (Creatine Kinase).

Link Directly to Fulltext Article at Science Direct

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Unique Identifier:9809950

Authors: Kuhl U. Lauer B. Souvatzoglu M. Vosberg H. Schultheiss HP.

Institution: Universitatsklinikum Benjamin Franklin, Abteilung Kardiologie, Berlin, Germany.

Title: Antimyosin scintigraphy and immunohistologic analysis of endomyocardial biopsy in patients with clinically suspected myocarditis--evidence of myocardial cell damage and inflammation in the absence of histologic signs of myocarditis.

Source: Journal of the American College of Cardiology. 32(5):1371-6, 1998 Nov.

Abstract: OBJECTIVES: This study compares the results of antimyosin scintigraphy in patients with clinically suspected myocarditis with histologic and immunohistologic findings in the endomyocardial biopsy. BACKGROUND: In patients with clinically suspected myocarditis, antimyosin scintigraphy often demonstrates myocardial cell damage but histologic evaluation of the endomyocardial biopsy often fails to show evidence of myocarditis. Recently developed immunohistologic techniques appear to be more sensitive for the detection of myocardial inflammation than histologic analysis alone. Studies comparing antimyosin scintigraphy and immunohistologic analysis of the endomyocardial biopsy in patients with clinically suspected myocarditis are not yet available. METHODS: Sixty-five patients with clinically suspected myocarditis underwent antimyosin scintigraphy. Antimyosin antibody uptake was correlated with histologic and immunohistologic findings in the endomyocardial biopsy. RESULTS: Antimyosin scintigraphy showed evidence of myocardial cell damage in 36 (55%) of the 65 patients and was negative in 29 (45%) patients. Histologic analysis of the endomyocardial biopsy revealed myocarditis in nine patients: six had a positive and three had a negative antimyosin scan, respectively. Thirty (83%) of 36 patients with evidence of myocardial cell damage on antimyosin scintigraphy were histologically negative for myocarditis. Immunohistologic analysis showed evidence of myocarditis in 31 (86%) of 36 patients with a positive antimyosin scan and also in 17 (59%) of 29 patients with a normal scan (p < 0.047). CONCLUSIONS: Antimyosin scintigraphy often shows myocyte injury in patients with clinically suspected myocarditis. Histologic analysis of the endomyocardial biopsy alone is often negative, but additional immunohistologic analysis of the endomyocardial biopsy frequently provides evidence of myocardial inflammation in these patients. With immunohistologic analysis as the reference method, antimyosin scintigraphy has a high specificity but a lower sensitivity for the detection of myocarditis. CAS Registry/EC Number 0 (Antibodies, Monoclonal). EC 3-6-1-4 (Myosins).

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Unique Identifier:8902668

Authors: Narula J. Khaw BA. Dec GW. Palacios IF. Newell JB. Southern JF. Fallon JT. Strauss HW. Haber E. Yasuda T.

Institution: Cardiac Unit, Nuclear Medicine Division, Massachusetts General Hospital, Boston 02114, USA.

Title: Diagnostic accuracy of antimyosin scintigraphy in suspected myocarditis.[comment].

Source: Journal of Nuclear Cardiology. 3(5):371-81, 1996 Sep-Oct.

Abstract: BACKGROUND: Radiolabeled antibody specific for cardiac myosin administered intravenously has been used to define noninvasively regions of myocardial necrosis. Inflammatory heart disorders such as myocarditis and heart transplant rejection demonstrate diffuse and often faint myocardial uptake of antimyosin antibody. This study was undertaken to evaluate the reproducibility and diagnostic accuracy of antimyosin antibody imaging for the detection of patients with suspected myocarditis. METHODS AND RESULTS: Fifty antimyosin scans, performed consecutively in patients with suspected myocarditis, were evaluated by one independent observer and two panels of observers. Antimyosin scan interpretations were compared with endomyocardial biopsy results and also with serial changes in left ventricular function. [....]  CONCLUSIONS: This study demonstrates a high degree of interobserver reproducibility of antimyosin interpretation. Comparison of the scintigraphic results with histologic and clinical standards indicates a high sensitivity of antimyosin scans for the detection of myocarditis. The antimyosin scan is also not likely to miss clinically or pathologically diagnosed myocarditis, in contrast to the endomyocardial biopsy, which missed clinically validated myocarditis 65% of time. The combination of high sensitivity and negative predictive value suggests that antimyosin scintigraphy may be an effective screening procedure for obviating biopsies in patients with suspected myocarditis. CAS Registry/EC Number 0 (Anti-Inflammatory Agents, Steroidal). 0 (Immunosuppressive Agents). 0 (Indium Radioisotopes). 446-86-6 (Azathioprine). 53-03-2 (Prednisone). EC 3-6-1-4 (Myosins).

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Unique Identifier:8026015

Authors: Martin AB. Webber S. Fricker FJ. Jaffe R. Demmler G. Kearney D. Zhang YH. Bodurtha J. Gelb B. Ni J. et al.

Institution: Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston 77030.

Title: Acute myocarditis. Rapid diagnosis by PCR in children.

Source: Circulation. 90(1):330-9, 1994 Jul.

Abstract: BACKGROUND: The diagnosis of viral myocarditis remains difficult and generally depends on clinical and histological criteria. Viral cultures and serology are often unrewarding, with low yields. The purpose of this study was to analyze the usefulness of polymerase chain reaction (PCR) in the rapid diagnosis of acute myocarditis in children. METHODS AND RESULTS: PCR was used to analyze 38 myocardial tissue samples from 34 patients with suspected acute viral myocarditis and 17 control patients with congenital heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples were obtained at the time of right ventricular biopsy (13 samples), from explanted hearts (18 samples) at transplantation, and from cardiac autopsy specimens (24 samples) and were evaluated for the presence of enterovirus, cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR primers designed to consensus and unique sequences of these viral genomes. Blood also was obtained at the time of biopsy (11) or transplant (18). In 26 of 38 myocardial samples (68%), viral genome was detected by PCR (15 adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial samples and blood samples were negative. Four patients had positive viral cultures, and these matched the PCR findings. Disagreement with histopathology occurred in 13 of 26 PCR-positive specimens, usually associated with adenovirus. CONCLUSIONS: PCR offers a rapid, sensitive diagnostic method for myocardial viral infection. While enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought. PCR used in conjunction with standard endomyocardial biopsy appears to enhance the likelihood of detecting viral genome in the myocardium of patients with clinical evidence of myocarditis. CAS Registry/EC Number 0 (Molecular Probes).

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Unique Identifier:3400607

Authors: Pinamonti B. Alberti E. Cigalotto A. Dreas L. Salvi A. Silvestri F. Camerini F.

Institution: Divisione di Cardiologia, Universita degli Studi, Trieste, Italy.

Title: Echocardiographic findings in myocarditis.

Source: American Journal of Cardiology. 62(4):285-91, 1988 Aug 1.

Abstract: This study analyzes morphologic and functional alterations detected by M-mode and 2-dimensional echocardiography in 41 patients with histologically proven myocarditis and different clinical presentations: congestive heart failure (63%), atrioventricular block (17%), chest pain (15%) and supraventricular arrhythmias (5%). Left ventricular dysfunction was common (69%), particularly in patients with congestive heart failure (88%), often without or with minor cavity dilatation. Patients with atrioventricular block or chest pain had usually preserved ventricular function. Right ventricular dysfunction was present in 23%. Additional findings included asynergic ventricular areas (64%), left ventricular "hypertrophy" sometimes reversible (20%), hyperrefractile myocardial areas (23%), ventricular thrombi (15%) and "restrictive" ventricular filling (7%). It is concluded that echocardiographic features of myocarditis are polymorphous and nonspecific. The echocardiographic pattern can simulate alternatively dilated, hypertrophic, restrictive or "right" ventricular cardiomyopathy, as well as coronary artery disease. In an appropriate clinical context, echocardiography can be helpful in the diagnosis of myocarditis and in the selection of patients for endomyocardial biopsy.

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Unique Identifier:3455232

Authors: Aretz HT. Billingham ME. Edwards WD. Factor SM. Fallon JT. Fenoglio JJ Jr. Olsen EG. Schoen FJ.

Institution: Department of Pathology, Lahey Clinic Medical Center, Burlington, Massachusetts.

Title: Myocarditis. A histopathologic definition and classification.

Source: American Journal of Cardiovascular Pathology. 1(1):3-14, 1987 Jan.