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Myhr KA, Zinglersen AH, Pecini R, Jacobsen S. Myocardial fibrosis associates with lupus anticoagulant in patients with systemic lupus erythematosus. Int J Cardiovasc Imaging 2024; 40:127-137. [PMID: 37814154 PMCID: PMC10774215 DOI: 10.1007/s10554-023-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that carries increased risk of cardiovascular disease; however, the underlying pathophysiological mechanisms remain poorly understood. We aimed to investigate the prevalence and degree of myocardial fibrosis in SLE patients and associated disease characteristics. Forty-nine SLE patients (89% female, mean age 52 ± 13 years, median disease duration 19 (11-25) years) and 79 sex-and age-matched healthy controls were included. CMR with T1 mapping was performed on SLE patients and healthy controls. Fifty-one SLE patients received gadolinium contrast for the evaluation of late gadolinium enhancement (LGE) and extra cellular volume (ECV). Multiple linear regression analyses were performed to investigate the association between markers of myocardial fibrosis on CMR (LGE, T1, ECV) and SLE-related variables [clinical disease activity, lupus nephritis, chronic kidney disease, anti-cardiolipin and/or anti-beta-2 glycoprotein I antibodies, and lupus anticoagulant (LAC)] with adjustment for traditional risk factors. T1 values were elevated in SLE patients compared to healthy controls (1031 ± 36 ms vs. 1019 ± 25 ms, p = 0.01). LGE was present in 20% of SLE patients who received gadolinium contrast. On multivariable analysis, LAC was associated with LGE in SLE patients (β = 3.87, p = 0.02). Neither T1 nor ECV associated with SLE disease characteristics; however, there was a trend towards an association between LAC and T1 (β = 16.9, p = 0.08). SLE patients displayed signs of myocardial fibrosis on CMR that were associated with the presence of LAC. These findings support the pathophysiological understanding of LAC as a mediator of microvascular and subsequent myocardial dysfunction.
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Affiliation(s)
- Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Amanda H Zinglersen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
| | - Redi Pecini
- Department of Cardiology, Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, Center for Rheumatology and Spine Diseases, Rigshospitalet, Juliane Maries Vej 10, 2100, Copenhagen, Denmark.
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2
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Gao Q, Yi W, Gao C, Qi T, Li L, Xie K, Zhao W, Chen W. Cardiac magnetic resonance feature tracking myocardial strain analysis in suspected acute myocarditis: diagnostic value and association with severity of myocardial injury. BMC Cardiovasc Disord 2023; 23:162. [PMID: 36977995 PMCID: PMC10053471 DOI: 10.1186/s12872-023-03201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Albeit that cardiac magnetic resonance feature tracking (CMR-FT) has enabled quantitative assessment of global myocardial strain in the diagnosis of suspected acute myocarditis, the cardiac segmental dysfunction remains understudied. The aim of the present study was using CMR-FT to assess the global and segmental dysfunction of the myocardium for diagnosis of suspected acute myocarditis. METHODS Forty-seven patients with suspected acute myocarditis (divided into impaired and preserved left ventricular ejection fraction [LVEF] groups) and 39 healthy controls (HCs) were studied. A total of 752 segments were divided into three subgroups, including segments with non-involvement (SNi), segments with edema (SE), and segments with both edema and late gadolinium enhancement (SE+LGE). 272 healthy segments served as the control group (SHCs). RESULTS Compared with HCs, patients with preserved LVEF showed impaired global circumferential strain (GCS) and global longitudinal strain (GLS). Segmental strain analysis showed that the peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) values significantly reduced in SE+LGE compared with SHCs, SNi, SE. PCS significantly reduced in SNi (-15.3 ± 5.8% vs. -20.3 ± 6.4%, p < 0.001) and SE (-15.2 ± 5.6% vs. -20.3 ± 6.4%, p < 0.001), compared with SHCs. The area under the curve (AUC) values of GLS (0.723) and GCS (0.710) were higher than that of global peak radial strain (0.657) in the diagnosis of acute myocarditis, but the difference was not statistically significant. Adding the Lake Louise Criteria to the model resulted in a further increase in diagnostic performance. CONCLUSIONS Global and segmental myocardial strain were impaired in patients with suspected acute myocarditis, even in the edema or relatively non-involved regions. CMR-FT may serve as an incremental tool for assessment of cardiac dysfunction and provide important additional imaging-evidence for distinguishing the different severity of myocardial injury in myocarditis.
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Affiliation(s)
- Qian Gao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Wenfang Yi
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Chao Gao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Tianfu Qi
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Lili Li
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Kaipeng Xie
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Wei Zhao
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, 295, Xichang Road, Wuhua District, Kunming, 650032, Yunnan Province, Republic of China.
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Ponzoni M, Coles JG, Maynes JT. Rodent Models of Dilated Cardiomyopathy and Heart Failure for Translational Investigations and Therapeutic Discovery. Int J Mol Sci 2023; 24:3162. [PMID: 36834573 PMCID: PMC9963155 DOI: 10.3390/ijms24043162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Even with modern therapy, patients with heart failure only have a 50% five-year survival rate. To improve the development of new therapeutic strategies, preclinical models of disease are needed to properly emulate the human condition. Determining the most appropriate model represents the first key step for reliable and translatable experimental research. Rodent models of heart failure provide a strategic compromise between human in vivo similarity and the ability to perform a larger number of experiments and explore many therapeutic candidates. We herein review the currently available rodent models of heart failure, summarizing their physiopathological basis, the timeline of the development of ventricular failure, and their specific clinical features. In order to facilitate the future planning of investigations in the field of heart failure, a detailed overview of the advantages and possible drawbacks of each model is provided.
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Affiliation(s)
- Matteo Ponzoni
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Program in Translational Medicine, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - John G. Coles
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Program in Translational Medicine, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Jason T. Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Program in Molecular Medicine, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON M5G 1E2, Canada
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Al Turk Y, Lemor A, Fayed M, Kim H. Sjögren-related cardiomyopathy presenting with cardiogenic shock. BMJ Case Rep 2021; 14:e244451. [PMID: 34667036 PMCID: PMC8527134 DOI: 10.1136/bcr-2021-244451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/04/2022] Open
Abstract
Previous reports have described non-ischaemic cardiomyopathy related to a variety of autoimmune diseases. However, very few case reports describe Sjögren disease as a contributing factor to cardiomyopathy. We report the case of a 69-year-old woman with a history of Sjögren disease who presented with cardiogenic shock. Laboratory testing and cardiac MRI revealing apical septal late gadolinium enhancement were consistent with an autoimmune aetiology. After ruling out ischaemic, infectious and other possible causes, the patient's clinical presentation was thought to be related to underlying Sjögren disease. She was treated with intravenous steroids and evidence-based heart failure therapy, but she eventually died after having declined heart transplantation. Given the rarity of Sjögren disease, no diagnostic criteria or standard treatment has been established for cardiomyopathy related to this disease. Diagnosis should be considered in patients who show evidence of autoimmune processes after other possible causes are ruled out.
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Affiliation(s)
- Yahia Al Turk
- Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Alejandro Lemor
- Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan, USA
- Centro de Investigación de Epidemiología Clínica y Medicina Basada en la Evidencia, Universidad de San Martín de Porres Facultad de Medicina Humana, La Molina, Peru
| | - Mohamed Fayed
- Anesthesia, Henry Ford Health System, Detroit, Michigan, USA
| | - Henry Kim
- Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan, USA
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Zhu J, Chen Y, Xu Z, Wang S, Wang L, Liu X, Gao F. Non-invasive assessment of early and acute myocarditis in a rat model using cardiac magnetic resonance tissue tracking analysis of myocardial strain. Quant Imaging Med Surg 2020; 10:2157-2167. [PMID: 33139995 DOI: 10.21037/qims-20-122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Myocardial strain analysis can provide diagnostic and prognostic information for myocarditis. The aim of the present study was to assess early and acute myocarditis in a rat model using cardiac magnetic resonance tissue tracking (CMR-TT) for myocardial strain analysis. We compared the strain's findings with the histological and immunohistochemical results. Methods Experimental autoimmune myocarditis (EAM) was induced by footpad injections of porcine cardiac myosin. The rats were examined by 7.0T preclinical CMR at day 14 (n=15) and day 21 (n=16) after EAM induction and the two control groups (each n=15) were also examined at day 14 and day 21, respectively. Using CMR-TT, we found a global peak systolic radial strain (ErrSAX) and a circumferential strain (EccSAX) from the short-axis cine views and a radial strain (ErrLAX) and a longitudinal strain (EllLAX) from the long-axis cine views, which were calculated by dedicated TT software. Subsequently, histological and immunohistochemical evaluations were performed. Results EllLAX significantly decreased in early myocarditis compared with the control (-23.40%±1.48% vs. -22.02%±0.81%, P<0.05). ErrSAX, EccSAX, ErrLAX, and EllLAX values significantly reduced in acute myocarditis compared with the controls (ErrSAX: 34.27%±9.80% vs. 49.76%±4.97%, EccSAX: -18.98%±3.69% vs. -24.13±1.23, ErrLAX: 33.21%±10.24% vs. 49.59%±5.69%, and EllLAX: -17.75%±3.58% vs. -23.39%±1.48%; P<0.001, respectively). The receiver operating characteristic curve showed that myocardial strain analysis had a good diagnostic performance in early and acute myocarditis. The pathological evaluation revealed that inflammatory lesions began to appear in early myocarditis and peaked in acute myocarditis. Conclusions The CMR-TT strain analysis allowed accurate and reliable evaluation of early and acute myocarditis in a rat model, and has the potential to serve as a diagnostic indicator for the assessment of myocardial dysfunction in myocarditis.
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Affiliation(s)
- Jing Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yushu Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyu Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxin Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fabao Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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Werner RA, Wakabayashi H, Bauer J, Schütz C, Zechmeister C, Hayakawa N, Javadi MS, Lapa C, Jahns R, Ergün S, Jahns V, Higuchi T. Longitudinal 18F-FDG PET imaging in a rat model of autoimmune myocarditis. Eur Heart J Cardiovasc Imaging 2019; 20:467-474. [PMID: 30102319 PMCID: PMC6429237 DOI: 10.1093/ehjci/jey119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/25/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Although mortality rate is very high, diagnosis of acute myocarditis remains challenging with conventional tests. We aimed to elucidate the potential role of longitudinal 2-Deoxy-2-18F-fluoro-D-glucose (18F-FDG) positron emission tomography (PET) inflammation monitoring in a rat model of experimental autoimmune myocarditis. METHODS AND RESULTS Autoimmune myocarditis was induced in Lewis rats by immunizing with porcine cardiac myosin emulsified in complete Freund's adjuvant. Time course of disease was assessed by longitudinal 18F-FDG PET imaging. A correlative analysis between in- and ex vivo18F-FDG signalling and macrophage infiltration using CD68 staining was conducted. Finally, immunohistochemistry analysis of the cell-adhesion markers CD34 and CD44 was performed at different disease stages determined by longitudinal 18F-FDG PET imaging. After immunization, myocarditis rats revealed a temporal increase in 18F-FDG uptake (peaked at week 3), which was followed by a rapid decline thereafter. Localization of CD68 positive cells was well correlated with in vivo18F-FDG PET signalling (R2 = 0.92) as well as with ex vivo18F-FDG autoradiography (R2 = 0.9, P < 0.001, respectively). CD44 positivity was primarily observed at tissue samples obtained at acute phase (i.e. at peak 18F-FDG uptake), while CD34-positive staining areas were predominantly identified in samples harvested at both sub-acute and chronic phases (i.e. at 18F-FDG decrease). CONCLUSION 18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research (IZKF), University of Würzburg, Josef-Schneider-Str. 2, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Jochen Bauer
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Claudia Schütz
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Christina Zechmeister
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Nobuyuki Hayakawa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University Hospital Würzburg, Straubmühlweg 2a, Würzburg, Germany
| | - Süleyman Ergün
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Valerie Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Biomedical Imaging, National Cerebral and Cardiovascular Research Center, 5 Chome-7-1 Fujishirodai, Suita, Osaka Prefecture, Japan
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Zhong C, Wu Y, Chang H, Liu C, Zhou L, Zou J, Qi Z. Effect of PKC inhibitor on experimental autoimmune myocarditis in Lewis rats. Oncotarget 2017; 8:54187-54198. [PMID: 28903333 PMCID: PMC5589572 DOI: 10.18632/oncotarget.17018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/31/2017] [Indexed: 12/19/2022] Open
Abstract
Myocarditis is a major cause of sudden, unexpected death in young people. However, it is still one of the most challenging diseases to treat in cardiology. In the present study, we showed that both expression level and activity of PKC-α were up-regulated in the rat heart of experimental autoimmune myocarditis (EAM). Intraperitoneal administration of PKC inhibitor (Ro-32-0432) at the end of the most severe inflammation period of EAM still significantly reduced the EAM induced expression of failure biomarkers. Furthermore, Ro-32-0432 reduced the ratio of Bax/Bcl-2 and suppressed the expression of cleaved caspase-3, both of which were increased in the heart of the EAM rats, suggesting an anti-apoptotic role of Ro-32-0432. Besides, Ro-32-0432 suppressed EAM-induced cardiac fibrosis and release of pro-inflammatory cytokines IL-1β and IL-17. These results suggest that inhibition of PKC may serve as a potential therapeutic strategy for the treatment of myocarditis.
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Affiliation(s)
- Chunlian Zhong
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China
| | - Yang Wu
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China.,Xiamen Cardiovascular Hospital, Medical College of Xiamen University, Xiamen, China
| | - He Chang
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China.,Xiamen Cardiovascular Hospital, Medical College of Xiamen University, Xiamen, China
| | - Chunxiao Liu
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China.,Xiamen Cardiovascular Hospital, Medical College of Xiamen University, Xiamen, China
| | - Li Zhou
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China
| | - Jun Zou
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China
| | - Zhi Qi
- Department of Basic Medical Sciences, Medical College of Xiamen University, Xiang'an Nan Lu, Xiamen, China
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8
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Jeuthe S, Wassilew K, O h-Ici D, da Silva TF, Münch F, Berger F, Kuehne T, Pieske B, Messroghli DR. Myocardial T1 maps reflect histological findings in acute and chronic stages of myocarditis in a rat model. J Cardiovasc Magn Reson 2016; 18:19. [PMID: 27084492 PMCID: PMC4833926 DOI: 10.1186/s12968-016-0241-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance offers both diagnostic and prognostic information in myocarditis. Using an established animal model of myocarditis, the aim of this study was to measure myocardial T1 before the onset, in the acute and in the chronic phases of the disease and to compare its course with histological and immunohistochemistry findings. METHODS Male young Lewis rats were immunized with 0.25 mg porcine myocardial myosin into the rear footpads on day 0. Native and contrast-enhanced ECG-triggered cardiac MRI examinations were performed before immunization on day 0 and on days 14, 21 and 35. Left ventricular function, pre- and post- contrast T1 parameters and LGE images were assessed using Small animal look-locker inversion recovery (SALLI). For each of the indicated time points a minimum of 4 rats were randomly sacrificed for pathological investigations including conventional histology (HE and Sirius-Red staining) and immunohistochemistry (CD 68) investigations. RESULTS All immunized rats developed myocarditis (morbidity 100%). Histologically we observed increased wall thickness with biventricular macrophage-rich mixed inflammatory infiltrates. All rats with a histologically severe myocarditis showed increased native T1 and decreased post-contrast T1 of the myocardium. CONCLUSIONS The assessment of native T1 and post-contrast T1 allows accurate differentiation between healthy myocardium and myocardium with inflammation and also between the acute and chronic phases of the disease.
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MESH Headings
- Acute Disease
- Animals
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Autoimmune Diseases/chemically induced
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Autoimmune Diseases/physiopathology
- Cardiomyopathy, Dilated/chemically induced
- Cardiomyopathy, Dilated/immunology
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/physiopathology
- Chronic Disease
- Disease Models, Animal
- Immunohistochemistry
- Magnetic Resonance Imaging
- Male
- Myocarditis/chemically induced
- Myocarditis/immunology
- Myocarditis/pathology
- Myocarditis/physiopathology
- Myocardium/immunology
- Myocardium/pathology
- Myosins
- Predictive Value of Tests
- Rats, Inbred Lew
- Time Factors
- Ventricular Function, Left
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Affiliation(s)
- Sarah Jeuthe
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Wassilew
- />Cardiovascular Pathology, Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Darach O h-Ici
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Tiago Ferreira da Silva
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Frédéric Münch
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Felix Berger
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Daniel R. Messroghli
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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9
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Biesbroek PS, Beek AM, Germans T, Niessen HWM, van Rossum AC. Diagnosis of myocarditis: Current state and future perspectives. Int J Cardiol 2015; 191:211-9. [PMID: 25974197 DOI: 10.1016/j.ijcard.2015.05.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 01/17/2023]
Abstract
Myocarditis, i.e. inflammation of the myocardium, is one of the leading causes of sudden cardiac death (SCD) and dilated cardiomyopathy (DCM) in young adults, and is an important cause of symptoms such as chest pain, dyspnea and palpitations. The pathophysiological process of disease progression leading to DCM involves an ongoing inflammation as a result of a viral-induced auto-immune response or a persisting viral infection. It is therefore crucial to detect the disease early in its course and prevent persisting inflammation that may lead to DCM and end-stage heart failure. Because of the highly variable clinical presentation, ranging from mild symptoms to severe heart failure, and the limited available diagnostic tools, the evaluation of patients with suspected myocarditis represents an important clinical dilemma in cardiology. New approaches for the diagnosis of myocarditis are needed in order to improve recognition, to help unravel its pathophysiology, and to develop new therapeutic strategies to treat the disease. In this review, we give a comprehensive overview of the current diagnostic strategies for patients with suspected myocarditis, and demonstrate several new techniques that may help to improve the diagnostic work-up.
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Affiliation(s)
- P Stefan Biesbroek
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands; Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU), Amsterdam, The Netherlands.
| | - Aernout M Beek
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU), Amsterdam, The Netherlands
| | | | - Hans W M Niessen
- Department of Pathology and Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU), Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; Institute for Cardiovascular Research of the Vrije Universiteit of Amsterdam (ICaR-VU), Amsterdam, The Netherlands
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10
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Yilmaz A, Ferreira V, Klingel K, Kandolf R, Neubauer S, Sechtem U. Role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis of acute and chronic myocarditis. Heart Fail Rev 2014; 18:747-60. [PMID: 23076423 DOI: 10.1007/s10741-012-9356-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The aetiopathogenesis of acute and chronic myocarditis is rather complex as a great variety of infectious agents can induce cardiac inflammation. Moreover, many systemic and autoimmune diseases such as sarcoidosis, giant cell myocarditis and systemic lupus erythematodes, drugs and toxins have been described as non-infectious causes of inflammatory heart disorders. Myocarditis may cause sudden death and lead to dilated cardiomyopathy. The correct and timely diagnosis of myocarditis is still a difficult clinical challenge, since the clinical spectrum of myocarditis is broad and comprises (amongst others) even those patients with no symptoms or those presenting with acute cardiogenic shock. Although endomyocardial biopsy still represents the gold standard for the diagnosis of myocarditis, new non-invasive imaging techniques such as cardiovascular magnetic resonance (CMR) imaging promise the non-invasive diagnosis of myocarditis. Considering the hallmarks of acute and chronic myocarditis (accumulation of inflammatory cells; swelling, necrosis and/or apoptosis of cardiomyocytes; increase in extracellular space and water content; myocardial remodelling with fibrotic tissue replacement), an imaging modality such as CMR that enables non-invasive detection of changes in myocardial tissue composition is highly valuable and welcome. This review will focus on the 'clinical role' of CMR in the diagnosis of acute and chronic myocarditis.
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Affiliation(s)
- Ali Yilmaz
- Division of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany,
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Schmerler P, Jeuthe S, O h-Ici D, Wassilew K, Lauer D, Kaschina E, Kintscher U, Müller S, Muench F, Kuehne T, Berger F, Unger T, Steckelings UM, Paulis L, Messroghli D. Mortality and morbidity in different immunization protocols for experimental autoimmune myocarditis in rats. Acta Physiol (Oxf) 2014; 210:889-98. [PMID: 24410878 DOI: 10.1111/apha.12227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/04/2013] [Accepted: 01/06/2014] [Indexed: 01/22/2023]
Abstract
AIM We aimed to investigate the histological and clinical presentations of experimental autoimmune myocarditis (EAM) induced by different immunization schemes. METHODS Male young Lewis rats were divided into five groups immunized by porcine myocardial myosin: subcutaneously (SC) 2 mg (in two 1-mg doses on day 0 and 7), 0 mg (sham group) subcutaneously into rear footpads (RF), 0.25 mg RF, 0.5 mg RF or 1 mg RF (all RF once on day 0). On day 21, left ventricular (LV) function was assessed by cardiac magnetic resonance imaging and cardiac catheterization. The type and degree of myocardial inflammatory infiltrates were determined by conventional histology and immunohistochemistry. RESULTS In the SC immunized rats and in the RF sham group, we observed 0% mortality, while in the actively RF immunized rats, mortality was 20, 20 and 44% for the 0.25 mg, 0.5 mg and 1 mg myosin doses respectively. Morbidity as defined by inflammatory infiltrates on haematoxylin and eosin (HE) staining was 22% in the SC immunized rats, 0% in the RF sham group and 100% in all actively RF immunized groups. We observed augmented relative ventricle weight and spleen weight, increased LV end-diastolic pressure, reduced LV developed pressure and reduced LV ejection fraction in all with myosin-immunized RF groups without any systematic dose effect. CONCLUSION Subcutaneous immunization to the neck and flanks did not induce a reproducible EAM, while RF myosin administration reliably led to EAM. Lower myosin doses seem to induce the complete histological and clinical picture of EAM while being associated with lower mortality, non-specific symptoms and animal distress.
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Affiliation(s)
- P. Schmerler
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
| | - S. Jeuthe
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
| | - D. O h-Ici
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
| | - K. Wassilew
- Department of Pathology; German Heart Institute; Berlin Germany
| | - D. Lauer
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
| | - E. Kaschina
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
| | - U. Kintscher
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
| | - S. Müller
- Experimental Neurology; Charité-University Medicine; Berlin Germany
| | - F. Muench
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
| | - T. Kuehne
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
| | - F. Berger
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
| | - T. Unger
- CARIM-School for Cardiovascular Diseases; Maastricht University; Maastricht the Netherlands
| | - U. M. Steckelings
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
- Department of Cardiovascular and Renal Research; University of Southern Denmark; Odense Denmark
| | - L. Paulis
- Center for Cardiovascular Research; Charité-University Medicine; Berlin Germany
- Institute of Pathophysiology; Faculty of Medicine; Comenius University; Bratislava Slovak Republic
| | - D. Messroghli
- Congenital Heart Disease and Pediatric Cardiology; German Heart Institute; Berlin Germany
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Francone M, Chimenti C, Galea N, Scopelliti F, Verardo R, Galea R, Carbone I, Catalano C, Fedele F, Frustaci A. CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imaging 2014; 7:254-63. [PMID: 24560214 DOI: 10.1016/j.jcmg.2013.10.011] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether clinical presentation and type of cell death in acute myocarditis might contribute to cardiac magnetic resonance (CMR) sensitivity. BACKGROUND Growing evidence indicates CMR is the reference noninvasive tool for the diagnosis of acute myocarditis. However, factors affecting CMR sensitivity are still unclear. METHODS We retrospectively evaluated 57 consecutive patients with a diagnosis of acute myocarditis made on the basis of clinical history (≤3 months) and endomyocardial biopsy evidence of lymphocytic infiltrates (≥14 infiltrating leukocytes/mm(2) at immunohistochemistry) in association with damage of the adjacent myocytes and absence or minimal evidence of myocardial fibrosis. CMR acquisition protocol included T2-weighted (edema), early (hyperemia), and late (fibrosis/necrosis) gadolinium enhancement sequences. Presence of ≥2 CMR criteria denoted myocarditis. Type of cell death was evaluated by using in situ ligation with hairpin probes. RESULTS Three clinical myocarditis patterns were recognized: infarct-like (pattern 1, n = 21), cardiomyopathic (pattern 2, n = 21), and arrhythmic (pattern 3, n = 15). Tissue edema was observed in 81% of pattern 1, 28% of pattern 2, and 27% of pattern 3. Early enhancement was evident in 71% of pattern 1, 67% of pattern 2, and 40% of pattern 3. Late gadolinium enhancement was documented in 71% of pattern 1, 57% of pattern 2, and 47% of pattern 3. CMR sensitivity was significantly higher in pattern 1 (80%) compared with pattern 2 (57%) and pattern 3 (40%) (p < 0.05). Cell necrosis was the prevalent mechanism of death in pattern 1 compared with pattern 2 (p < 0.001) and pattern 3 (p < 0.05), whereas apoptosis prevailed in pattern 2 (p < 0.001 vs. pattern 1 and p < 0.05 vs. pattern 3). CONCLUSIONS In acute myocarditis, CMR sensitivity is high for infarct-like, low for cardiomyopathic, and very low for arrhythmic clinical presentation; it correlates with the extent of cell necrosis-promoting expansion of interstitial space.
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Affiliation(s)
- Marco Francone
- Department of Radiology, Oncology and Pathology, La Sapienza University, Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy; IRCCS San Raffaele La Pisana, Rome, Italy
| | - Nicola Galea
- Department of Radiology, Oncology and Pathology, La Sapienza University, Rome, Italy
| | | | | | - Roberto Galea
- Fondazione IRCSS Ospedale Maggiore Policlinico Università degli Studi di Milano, Rome, Italy
| | - Iacopo Carbone
- Department of Radiology, Oncology and Pathology, La Sapienza University, Rome, Italy
| | - Carlo Catalano
- Department of Radiology, Oncology and Pathology, La Sapienza University, Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy
| | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy; IRCCS L. Spallanzani, Rome, Italy.
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Jeuthe S, O H-Ici D, Kemnitz U, Dietrich T, Schnackenburg B, Berger F, Kuehne T, Messroghli D. Assessment of cardiac function and myocardial morphology using small animal Look-Locker inversion recovery (SALLI) MRI in rats. J Vis Exp 2013. [PMID: 23912668 DOI: 10.3791/50397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Small animal magnetic resonance imaging is an important tool to study cardiac function and changes in myocardial tissue. The high heart rates of small animals (200 to 600 beats/min) have previously limited the role of CMR imaging. Small animal Look-Locker inversion recovery (SALLI) is a T1 mapping sequence for small animals to overcome this problem. T1 maps provide quantitative information about tissue alterations and contrast agent kinetics. It is also possible to detect diffuse myocardial processes such as interstitial fibrosis or edema. Furthermore, from a single set of image data, it is possible to examine heart function and myocardial scarring by generating cine and inversion recovery-prepared late gadolinium enhancement-type MR images. The presented video shows step-by-step the procedures to perform small animal CMR imaging. Here it is presented with a healthy Sprague-Dawley rat, however naturally it can be extended to different cardiac small animal models.
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Affiliation(s)
- Sarah Jeuthe
- Congenital Heart Disease and Pediatric Cardiology, German Heart Institute Berlin, Berlin, Germany
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14
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Rinkevich-Shop S, Konen E, Kushnir T, Epstein FH, Landa-Rouben N, Goitein O, Ben Mordechai T, Feinberg MS, Afek A, Leor J. Non-invasive assessment of experimental autoimmune myocarditis in rats using a 3 T clinical MRI scanner. Eur Heart J Cardiovasc Imaging 2013; 14:1069-79. [PMID: 23644934 DOI: 10.1093/ehjci/jet044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS The aim of this study was to assess the use of a 3 T clinical cardiac magnetic resonance (CMR) scanner to detect injury to the heart in experimental autoimmune myocarditis (EAM). METHODS AND RESULTS The use of 3 T CMR for the detection of cardiac injury was assessed in EAM (n = 55) and control (n = 10) male Lewis rats. Animals were evaluated with serial CMR imaging studies, using a 3 T scanner, and with 2D echocardiography before, and at 2 and 5 weeks after EAM induction. By CMR, regional wall motion abnormalities were noted in seven out of eight rats with myocarditis 5 weeks after induction. Subsequently, the rats developed significant left ventricular (LV) dilatation, wall thickening, and pericardial effusion. Average LV systolic and diastolic volumes increased from 131 ± 10 to 257 ± 20 µL (P = 0.0008), and from 309 ± 14 to 412 ± 24 µL (P < 0.0001), and ejection fraction markedly deteriorated (from 58 ± 2 to 37 ± 5%; P = 0.0003). Areas of fibrosis were located by late gadolinium enhancement (LGE) CMR at the subepicardium, mainly within the anterior, lateral, and inferior walls. The extent and location of LGE were highly correlated (r = 0.94; P < 0.0001) with areas of myocardial fibrosis by histopathology, with 85% sensitivity and 86% specificity. CONCLUSION A clinical 3 T CMR scanner enables accurate detection, quantification, and monitoring of experimental myocarditis in rats, and could be used for translational research to study the pathophysiology of the disease and evaluate novel therapies.
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Affiliation(s)
- Shunit Rinkevich-Shop
- Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel
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Aguor ENE, van de Kolk CWA, Arslan F, Nederhoff MGJ, Doevendans PAFM, Pasterkamp G, Strijkers GJ, van Echteld CJA. 23Na chemical shift imaging and Gd enhancement of myocardial edema. Int J Cardiovasc Imaging 2012; 29:343-54. [PMID: 22790331 PMCID: PMC3560947 DOI: 10.1007/s10554-012-0093-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/27/2012] [Indexed: 12/24/2022]
Abstract
Myocardial edema can arise in several disease states. MRI contrast agent can accumulate in edematous tissue, which complicates differential diagnosis with contrast-enhanced (CE)-MRI and might lead to overestimation of infarct size. Sodium Chemical Shift Imaging ((23)Na-CSI) may provide an alternative for edema imaging. We have developed a non-infarct, isolated rat heart model with two levels of edema, which was studied with (23)Na-CSI and CE-MRI. In edematous, but viable tissue the extracellular sodium (Na (e) (+)) signal is hypothesized to increase, but not the intracellular sodium (Na (i) (+)) signal. Isolated hearts were perfused at 60 (n = 6) and 140 mmHg (n = 5). Dimethyl methylphosphonate (DMMP) and phenylphosphonate (PPA) were used to follow edema formation by (31)P-MR Spectroscopy. In separate groups, Thulium(III)1,4,7,10 tetraazacyclododecane-N,N',N″,N'''-tetra(methylenephosphonate) (TmDOTP(5-)) and Gadovist were used for (23)Na-CSI (n = 8) and CE-MRI (n = 6), respectively. PPA normalized signal intensity (SI) was higher at 140 versus 60 mmHg, with a ratio of 1.27 ± 0.12 (p < 0.05). The (DMMP-PPA)/dry weight ratio, as a marker of intracellular volume, remained unchanged. The mid-heart cross sectional area (CSA) of the left ventricle (LV) was significantly increased at 140 mmHg. In addition, at 140 mmHg, the LV Na (e) (+) SI increased with a 140 mmHg/60 mmHg ratio of 1.24 ± 0.18 (p < 0.05). Na (i) (+) SI remained essentially unchanged. With CE-MRI, a subendocardially enhanced CSA was identified, increasing from 0.20 ± 0.02 cm(2) at 60 mmHg to 0.31 ± 0.02 cm(2) at 140 mmHg (p < 0.05). Edema shows up in both CE-MRI and Na (e) (+) . High perfusion pressure causes more edema subendocardially than subepicardially. (23)Na-CSI is an attractive alternative for imaging of edema and is a promising tool to discriminate between edema, acute and chronic MI.
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Affiliation(s)
- Eissa N E Aguor
- Laboratory of Experimental Cardiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
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Patterns of myocardial late enhancement: Typical and atypical features. Arch Cardiovasc Dis 2012; 105:300-8. [DOI: 10.1016/j.acvd.2011.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/11/2011] [Accepted: 12/12/2011] [Indexed: 01/03/2023]
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Correlation of left ventricular wall thickness, heart mass, serological parameters and late gadolinium enhancement in cardiovascular magnetic resonance imaging of myocardial inflammation in an experimental animal model of autoimmune myocarditis. Int J Cardiovasc Imaging 2012; 28:1983-97. [DOI: 10.1007/s10554-012-0020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/17/2012] [Indexed: 12/26/2022]
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Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters. Eur Radiol 2010; 21:1259-66. [PMID: 21116631 PMCID: PMC3088804 DOI: 10.1007/s00330-010-2022-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 10/25/2010] [Indexed: 12/26/2022]
Abstract
Objective To evaluate the role of MRI in diagnosing acute myocarditis by correlation with immunohistological parameters. Methods A total of 131 patients (85 men, 46 women; mean age, 44.9 years) with suspected acute myocarditis were examined by MRI. The relative water content of the left ventricular myocardium as well as relative and late enhancement was correlated with the immunohistological results in biopsy specimens. Results Myocardial inflammation was confirmed by immunohistology in 82 of the 131 patients investigated and ruled out in 49 patients. The sensitivity, specificity and accuracy for diagnosing myocarditis in patients with immunohistologically proven disease were 48.8%, 73.8% and 57.3%, respectively, for relative enhancement, 58.3%, 57.1% and 57.9% for relative water content, and 30.6%, 88.1% and 49.6% for late enhancement. A combination of all three parameters had 39,3% sensitivity and 91,3% specificity and 62,7% accuracy. Relative enhancement and late enhancement significantly correlated with the presence of myocarditis but relative oedema did not. Conclusion Relative and late enhancement significantly correlate with the presence of myocarditis, while there is no significant correlation for relative oedema. Myocarditis cannot be reliably diagnosed using any of the three MRI parameters alone but combinations of parameters will improve specificity.
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Voigt A, Elgeti T, Durmus T, Idiz ME, Butler C, Beling M, Schilling R, Klingel K, Kandolf R, Stangl K, Taupitz M, Kivelitz D, Wagner M. Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults—towards identification of myocardial inflammation. Eur Radiol 2010; 21:925-35. [DOI: 10.1007/s00330-010-1985-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/30/2010] [Accepted: 09/10/2010] [Indexed: 01/07/2023]
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Korkusuz H, Esters P, Huebner F, Bug R, Ackermann H, Vogl TJ. Accuracy of cardiovascular magnetic resonance in myocarditis: comparison of MR and histological findings in an animal model. J Cardiovasc Magn Reson 2010; 12:49. [PMID: 20796268 PMCID: PMC2936396 DOI: 10.1186/1532-429x-12-49] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 08/26/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Because endomyocardial biopsy has low sensitivity of about 20%, it can be performed near to myocardium that presented as late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR). However the important issue of comparing topography of CMR and histological findings has not yet been investigated. Thus the current study was performed using an animal model of myocarditis. RESULTS In 10 male Lewis rats experimental autoimmune myocarditis was induced, 10 rats served as control. On day 21 animals were examined by CMR to compare topographic distribution of LGE to histological inflammation. Sensitivity, specificity, positive and negative predictive values for LGE in diagnosing myocarditis were determined for each segment of myocardium. Latter diagnostic values varied widely depending on topographic distribution of LGE and inflammation as well as on the used CMR sequence. Sensitivity of LGE was up to 76% (left lateral myocardium) and positive predictive values were up to 85% (left lateral myocardium), whereas sensitivity and positive predictive value dropped to 0-33% (left inferior myocardium). CONCLUSIONS Topographic distribution of LGE and histological inflammation seem to influence sensitivity, specificity, positive and negative predictive values. Nevertheless, positive predictive value for LGE of up to 85% indicates that endomyocardial biopsy should be performed "MR-guided". LGE seems to have greater sensitivity than endomyocardial biopsy for the diagnosis of myocarditis.
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Affiliation(s)
- Huedayi Korkusuz
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Philip Esters
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Frank Huebner
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Reinhold Bug
- Senckenberg Institute of Pathology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Hanns Ackermann
- Department of Biomathematics, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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