Author + information
- Received September 12, 2011
- Revision received November 16, 2011
- Accepted November 17, 2011
- Published online May 1, 2012.
- Philipp Lurz, MD, PhD⁎,⁎ (, )
- Ingo Eitel, MD⁎,
- Julia Adam, BSc†,
- Julia Steiner, BSc†,
- Matthias Grothoff, MD†,
- Steffen Desch, MD⁎,
- Georg Fuernau, MD⁎,
- Suzanne de Waha, MD⁎,
- Mahdi Sareban, MD⁎,
- Christian Luecke, MD†,
- Karin Klingel, MD‡,
- Reinhard Kandolf, MD‡,
- Gerhard Schuler, MD⁎,
- Matthias Gutberlet, MD† and
- Holger Thiele, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Philipp Lurz, University of Leipzig–Heart Center, Department of Internal Medicine/Cardiology, Struempellstrasse 39, 04289 Leipzig, Germany
Objectives 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).
Background 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.
Methods 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 T2-weighted imaging for assessment of edema, T1-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.
Results 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%).
Conclusions 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.
This work was supported by the Deutsche Forschungsgemeinschaft (SFB TR19) and the Federal Ministry of Education and Research (01EZ0817) to Drs. Klingel and Kandolf. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Gutberlet and Thiele contributed equally to this work.
- Received September 12, 2011.
- Revision received November 16, 2011.
- Accepted November 17, 2011.
- American College of Cardiology Foundation