Innovative Tools in the Workup of Acute Myocardits - “Maps created by cardiac MRI that may guide through therapy”
Background:
Myocarditis is an inflammatory disease of the heart frequently resulting from viral infections and/or autoimmune mediated responses. It’s a common cause of Dilative Cardiomyopathy, which is currently the most frequent reason for heart transplantation. The diagnosis of myocarditis remains challenging due to its varying clinical presentation and is based on non-invasive diagnostic tools such as Cardiovascular Magnetic Resonance (CMR). Newer CMR techniques quantifying native T1 and T2 relaxation times have improved diagnostic performance. Despite that, Endomyocardial Biopsy (EMB) remains the gold standard for in-vivo diagnosis of myocarditis.
Our Aims:
The aim of our group is to develop new strategies to enhance diagnostic workup for patients with suspected myocarditis. We focus on new CMR techniques such as T2 Mapping and compare our results to histological and immunhistochemical findings in EMB. In a previously published study we could demonstrate that T2 Mapping CMR offers the possibility to differentiate between patients with biopsy-proven myocarditis and healthy controls with an excellent diagnostic accuracy. However the prognostic implications of CMR in terms of clinical and functional recovery in this patient cohort remains unclear. Now we sought to assess the course of myocardial inflammation after acute myocarditis.
Fig. 1. Histological pictures of a patient with exclusion of myocarditis (a), moderate inflammation (b) and severe myocarditis (c+d).
Fig. 2. Myocardial T2 Maps during acute stage of disease and at follow-up examination after 12 months. T2 time as well as myocardial extent with abnormal raised T2 values is significant increased in acute myocarditis.
Literature:
- Bönner F, Janzarik N, Jacoby C, et al. Myocardial T2 mapping reveals age- and sex-related differences in volunteers. J Cardiovasc Magn Reson. 2015;17(1):9. doi:10.1186/s12968-015-0118-0.
- Bönner F, Spieker M, Stanske B, et al. T2-Mapping CMR increases the diagnostic sensitivity for detection of myocardial inflammation in patients with possible myocarditis - a prospective endomyocardial biopsy-controlled study. J Cardiovasc Magn Reson. 2015;17(Suppl 1):P319. doi:10.1186/1532-429X-17-S1-P319.
- Bönner F, Spieker M, Haberkorn S, et al. Myocardial T2 Mapping Increases Noninvasive Diagnostic Accuracy for Biopsy-Proven Myocarditis. JACC Cardiovasc Imaging. April 2016. doi:10.1016/j.jcmg.2015.11.014.
Cooperation: Dr. Bönner (UKD, Cardiology)