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Yeo SZJ, Ho CL. COVID-19 mRNA vaccine-related myocarditis: A PRISMA systematic review, imaging approach and differential diagnoses. Radiol Case Rep 2024; 19:1008-1019. [PMID: 38226053 PMCID: PMC10788373 DOI: 10.1016/j.radcr.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/28/2023] [Indexed: 01/17/2024] Open
Abstract
We present a case involving a young individual who developed acute myocarditis on the fourth day following administration of a COVID-19 mRNA vaccine. The patient's condition was managed conservatively, resulting in a favorable outcome. This paper extensively discusses the pathogenesis, clinical manifestations, imaging characteristics of COVID-19 mRNA vaccine-related myocarditis and includes a comprehensive review of pertinent literature. Additionally, a systematic review of COVID-19 mRNA vaccine-related myocarditis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles, is presented. Healthcare professionals should maintain a clinical suspicion for COVID-19 mRNA vaccine-related myocarditis when encountering patients with confirmed myocarditis who have received recent COVID-19 mRNA vaccination, after ruling out other potential causes. The diagnosis of acute myocarditis primarily relies on adherence to the Lake Louise Criteria (LLC) for cardiac magnetic resonance (CMR). Nevertheless, specific CMR features or distinctive patterns indicative of COVID-19 mRNA vaccine-related myocarditis are currently undefined. Among patients with vaccine-related myocarditis, common CMR findings encompass subepicardial late gadolinium enhancement and T2-based myocardial edema, although these findings lack specificity and may resemble other medical conditions. Supportive care involving a short-term regimen of NSAIDs, colchicine, and steroids represents the cornerstone of treatment for this variant of myocarditis, which tends to be self-limiting with favorable short-term prognoses. Timely diagnosis is paramount for optimizing patient care.
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Affiliation(s)
| | - Chi Long Ho
- Sengkang General Hospital, 110, Sengkang Eastway, 544886, Singapore
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Caobelli F, Cabrero JB, Galea N, Haaf P, Loewe C, Luetkens JA, Muscogiuri G, Francone M. Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy : A review paper with practical recommendations on behalf of the European Society of Cardiovascular Radiology (ESCR). Int J Cardiovasc Imaging 2023; 39:2221-2235. [PMID: 37682416 PMCID: PMC10674005 DOI: 10.1007/s10554-023-02927-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
Advanced cardiac imaging techniques such as cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) are widely used in clinical practice in patients with acute myocarditis and chronic inflammatory cardiomyopathies (I-CMP). We aimed to provide a review article with practical recommendations from the European Society of Cardiovascular Radiology (ESCR), in order to guide physicians in the use and interpretation of CMR and PET in clinical practice both for acute myocarditis and follow-up in chronic forms of I-CMP.
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Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 18, Bern, 3000, Switzerland.
| | | | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy
| | - Philip Haaf
- Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, and University of Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University Vienna, Spitalgasse 9, Vienna, A-1090, Austria
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
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Soeiro AM, Bossa AS, César MC, Leal TCAT, Garcia G, Fonseca RA, Nakamura D, Guimarães PO, Soeiro MCFA, Serrano CV, Soares PR, Mueller C, Mebazaa A, Fernandes F, Nomura CH, Rochitte CE, de Oliveira MT. The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis. Front Cardiovasc Med 2023; 10:1121083. [PMID: 37588035 PMCID: PMC10425551 DOI: 10.3389/fcvm.2023.1121083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/03/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction The role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients. Material and methods This was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction. Results The mean follow-up was 18.7 ± 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, p = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, p = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, p = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, p = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed. Conclusion Measurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
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Affiliation(s)
- Alexandre M. Soeiro
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Aline S. Bossa
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Maria C. César
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Guilherme Garcia
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rafael A. Fonseca
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Débora Nakamura
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Carlos V. Serrano
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo R. Soares
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- University Paris Diderot, Paris, France
- Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière, Paris, France
| | - Fábio Fernandes
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cesar H. Nomura
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos E. Rochitte
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Múcio T. de Oliveira
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Capasso R, Imperato MC, Serra N, Rodriguez R, Rivellini M, De Filippo M, Pinto A. Infarct-like versus Non-Infarct-like Clinical Presentation of Acute Myocarditis: Comparison of Cardiac Magnetic Resonance (CMR) Findings. Diagnostics (Basel) 2023; 13:2498. [PMID: 37568861 PMCID: PMC10416923 DOI: 10.3390/diagnostics13152498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The clinical presentation of acute myocarditis (AM) is widely variable, ranging from a subclinical disease to an infarct-like syndrome. Cardiac magnetic resonance (CMR) has become the reference non-invasive diagnostic tool for suspected AM, allowing the identification of the various hallmarks of myocardial inflammation (edema, fibrosis, and hyperemia). The aim of the study was to investigate any differences in morphological, functional, and tissue characterization CMR parameters between infarct-like AM in patients with unobstructed coronary arteries and non-infarct-like AM, diagnosed according to the original Lake-Louise Criteria (LLC); Methods: We retrospectively selected 39 patients diagnosed with AM according to LLC, divided into 2 groups according to the clinical presentation: infarct-like in group 1 patients and non-infarct-like in group 2 patients. CMR morphologic, functional, and tissue characterization parameters were analyzed and compared. RESULTS In group 1, CMR tissue characterization parameters were mainly altereda in septal location with mesocardial myocardial involvement; in group 2, CMR tissue characterization parameters were mainly altered in a lateral location with subepicardial myocardial involvement mainly at the mid-cavity. No significant differences in morphological or functional parameters were observed between the two study groups. CONCLUSIONS Our results showed differences in the localization and distribution of myocardial tissue damage assessed by CMR among forms of AM accompanied by an infarct-like clinical presentation compared with non-infarct-like presentations of AM. The mechanisms underlying the different preferential sites of damage observed in our study are not known, and we do not exclude the possibility of their prognostic implications.
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Affiliation(s)
- Raffaella Capasso
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Viale Colli Aminei 21, 80141 Naples, Italy (M.R.); (A.P.)
| | - Maria Chiara Imperato
- Department of Radiology, Santa Maria Incoronata dell’Olmo Hospital, 84013 Cava de’Tirreni, Italy;
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Reimy Rodriguez
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Viale Colli Aminei 21, 80141 Naples, Italy (M.R.); (A.P.)
| | - Maria Rivellini
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Viale Colli Aminei 21, 80141 Naples, Italy (M.R.); (A.P.)
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, Italy;
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Viale Colli Aminei 21, 80141 Naples, Italy (M.R.); (A.P.)
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Quantitative Assessment of Late Gadolinium Enhancement and Edema at Cardiac Magnetic Resonance in Low-Risk Myocarditis Patients. Tomography 2022; 8:974-984. [PMID: 35448712 PMCID: PMC9028348 DOI: 10.3390/tomography8020078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, we aimed to quantify LGE and edema at short-tau inversion recovery sequences on cardiac magnetic resonance (CMR) in patients with myocarditis. We retrospectively evaluated CMR examinations performed during the acute phase and at follow-up. Forty-seven patients were eligible for retrospective LGE assessment, and, among them, twenty-five patients were eligible for edema evaluation. Both groups were paired with age- and sex-matched controls. The median left ventricle LGE was 6.4% (interquartile range 5.0−9.2%) at the acute phase, 4.4% (3.3−7.2%) at follow-up, and 4.3% (3.0−5.3%) in controls, the acute phase being higher than both follow-up and controls (p < 0.001 for both), while follow-up and controls did not differ (p = 0.139). An optimal threshold of 5.0% was obtained for LGE with 87% sensitivity and 48% specificity; the positive likelihood ratio (LR) was 1.67, and the negative LR was 0.27. Edema was 12.8% (9.4−18.1%) at the acute phase, 7.3% (5.5−8.8%) at follow-up, and 6.7% (5.6−8.6%) in controls, the acute phase being higher than both follow-up and controls (both p < 0.001), while follow-up and controls did not differ (p = 0.900). An optimal threshold of 9.5% was obtained for edema with a sensitivity of 76% and a specificity of 88%; the positive LR was 6.33, and the negative LR was 0.27. LGE and edema thresholds are useful in cases of suspected mild myocarditis.
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Pommier T, Leclercq T, Guenancia C, Tisserand S, Lairet C, Carré M, Lalande A, Bichat F, Maza M, Zeller M, Cochet A, Cottin Y. More than 50% of Persistent Myocardial Scarring at One Year in "Infarct-like" Acute Myocarditis Evaluated by CMR. J Clin Med 2021; 10:jcm10204677. [PMID: 34682800 PMCID: PMC8541248 DOI: 10.3390/jcm10204677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) has emerged as a reference tool for the non-invasive diagnosis of myocarditis. However, its role in follow-up (FU) after the acute event is unclear. The objectives were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter and to identify the predictive factors of persistent myocardial scarring at one year. METHODS All patients with infarct-like acute myocarditis confirmed by CMR were included. CMR was performed within 8 days following symptom onset, at 3 months and at one year. One-year FU included ECG, a cardiac stress test, Holter recording, biological assessments, medical history and a quality-of-life questionnaire. Patients were classified according to the presence or absence of complete recovery at one year based on the CMR evaluation. RESULTS A total of 174 patients were included, and 147 patients had three CMR. At one year, 79 patients (54%) exhibited persistent myocardial scarring on CMR. A multivariate analysis showed that high peak troponin at the acute phase (OR: 3.0-95%CI: 1.16-7.96-p = 0.024) and the initial extent of late gadolinium enhancement (LGE) (OR: 1.1-95%CI: 1.03-1.19-p = 0.006) were independent predictors of persistent myocardial scarring. Moreover, patients with myocardial scarring on the FU CMR were more likely to have premature ventricular contractions during the cardiac stress test (25% versus 9%, p = 0.008). CONCLUSION Less than 50% of patients with infarct-like acute myocarditis showed complete recovery at one year. Although major adverse cardiac events were rare, ventricular dysrhythmias at one year were more frequent in patients with persistent myocardial scarring.
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Affiliation(s)
- Thibaut Pommier
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Correspondence: ; Tel.: +33-6-2645-6190; Fax: +33-3-8039-3333
| | - Thibault Leclercq
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
| | - Charles Guenancia
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Simon Tisserand
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
| | - Céline Lairet
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Max Carré
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Alain Lalande
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Laboratory ImVIA, EA 7535, University of Burgundy, 21000 Dijon, France
| | - Florence Bichat
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Maud Maza
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Marianne Zeller
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
| | - Alexandre Cochet
- Department of MRI, CHU, 21000 Dijon, France; (S.T.); (A.L.); (A.C.)
- Laboratory ImVIA, EA 7535, University of Burgundy, 21000 Dijon, France
| | - Yves Cottin
- Department of Cardiology, CHU Dijon-Bourgogne, 14 rue Gaffarel, CEDEX, 21079 Dijon, France; (T.L.); (C.G.); (C.L.); (M.C.); (F.B.); (M.M.); (M.Z.); (Y.C.)
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Sanguineti F, Garot J, Hovasse T, Unterseeh T, Champagne S, Garot P. [IRM et myocardite infectieuse]. Ann Cardiol Angeiol (Paris) 2020; 69:418-423. [PMID: 33069385 PMCID: PMC7556279 DOI: 10.1016/j.ancard.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/21/2022]
Abstract
Au cours des dix dernières années, l’IRM cardiaque est devenue un outil incontournable pour le diagnostic de myocardite aiguë. Elle peut, sous certaines conditions, permettre de surseoir à la coronarographie initiale dans de nombreuses situations. Son utilisation est préconisée en classe I, dans la situation du MINOCA, dans les recommandations de l’ESC de septembre 2020, pour permettre d’établir un diagnostic de certitude entre infarctus aigu, myocardite, Tako-Tsubo, ou autres cardiopathies en permettant d’améliorer la prise en charge thérapeutique et le suivi. Cet article reprend les principes techniques de l’IRM dans la myocardite (critères diagnostiques de Lake Louise et critères basés sur la cartographie tissulaire myocardique), les principaux diagnostics différentiels et la valeur pronostique, ainsi que la myocardite associée au COVID-19.
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Affiliation(s)
- F Sanguineti
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - J Garot
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France.
| | - T Hovasse
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - T Unterseeh
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - S Champagne
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - P Garot
- IRM cardiovasculaire, institut cardiovasculaire Paris Sud, hôpital Privé Jacques Cartier, Ramsay santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
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Gatti M, Carisio A, D'Angelo T, Darvizeh F, Dell'Aversana S, Tore D, Centonze M, Faletti R. Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: A review. World J Cardiol 2020; 12:248-261. [PMID: 32774777 PMCID: PMC7383353 DOI: 10.4330/wjc.v12.i6.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) necessitates documentation of an acute myocardial infarction (AMI), non-obstructive coronary arteries, using invasive coronary angiography or coronary computed tomography angiography and no clinically overt cause for AMI. Historically patients with MINOCA represent a clinical dilemma with subsequent uncertain clinical management. Differential diagnosis is crucial to choose the best therapeutic option for ischemic and non-ischemic MINOCA patients. Cardiovascular magnetic resonance (CMR) is able to analyze cardiac structure and function simultaneously and provides tissue characterization. Moreover, CMR could identify the cause of MINOCA in nearly two-third of patients providing valuable information for clinical decision making. Finally, it allows stratification of patients with worse outcomes which resulted in therapeutic changes in almost half of the patients. In this review we discuss the features of CMR in MINOCA; from exam protocols to imaging findings.
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Affiliation(s)
- Marco Gatti
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy.
| | - Andrea Carisio
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina 98100, Italy
| | - Fatemeh Darvizeh
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Serena Dell'Aversana
- Department of advanced biomedical sciences, University of Naples Federico II, Naples 80138, Italy
| | - Davide Tore
- Faletti Riccardo, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Maurizio Centonze
- Department of Diagnostic Imaging, APSS di Trento, Trento 38123, Italy
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Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients. Radiol Med 2020; 125:1249-1259. [PMID: 32367320 DOI: 10.1007/s11547-020-01204-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA). MATERIALS AND METHODS CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination. RESULTS Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan-Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13-24.7; p value = 0.002). CONCLUSION Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.
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Yang F, Wang J, Li W, Xu Y, Wan K, Zeng R, Chen Y. The prognostic value of late gadolinium enhancement in myocarditis and clinically suspected myocarditis: systematic review and meta-analysis. Eur Radiol 2020; 30:2616-2626. [DOI: 10.1007/s00330-019-06643-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022]
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Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, Kindermann I, Gutberlet M, Cooper LT, Liu P, Friedrich MG. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 2019; 72:3158-3176. [PMID: 30545455 DOI: 10.1016/j.jacc.2018.09.072] [Citation(s) in RCA: 1169] [Impact Index Per Article: 233.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Abstract
This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.
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Affiliation(s)
- Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin, Department of Cardiology and Helios-Klinikum, DZHK-Partnersite-Berlin, Germany
| | - Godtfred Holmvang
- Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher M Kramer
- Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Ingrid Kindermann
- Department of Internal Medicine III, Saarland University Medical Center, Homburg/Saar, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany
| | | | - Peter Liu
- Ottawa Heart Institute, Ottawa, Canada
| | - Matthias G Friedrich
- Heidelberg University Hospital, Heidelberg, Germany; Department of Cardiology, McGill University Health Centre, Montreal, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada.
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12
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Gatti M, Palmisano A, Faletti R, Benedetti G, Bergamasco L, Bioletto F, Peretto G, Sala S, De Cobelli F, Fonio P, Esposito A. Two-dimensional and three-dimensional cardiac magnetic resonance feature-tracking myocardial strain analysis in acute myocarditis patients with preserved ejection fraction. Int J Cardiovasc Imaging 2019; 35:1101-1109. [PMID: 30929101 DOI: 10.1007/s10554-019-01588-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022]
Abstract
To explore the potential role of two- (2D) and three-dimensional (3D) cardiac magnetic resonance (CMR) feature tracking (FT) myocardial strain analysis in identifying sub-clinical myocardial systolic and diastolic dysfunction in acute myocarditis patients with preserved ejection fraction (EF). Prospective two centre study-control study. Thirty patients (9 female, 37.2 ± 11.8 years.) with a CMR diagnosis of acute myocarditis according to the Lake Louise Criteria and preserved EF (≥ 55%) were included in the analysis. CMR data from 24 healthy volunteers (11 female, 36.2 ± 12.5 years.) served as control. 2D and 3D LV tissue tracking analysis were performed in a random fashion by two double-blinded operators. Variables were checked for normality and analysed with parametric test. The baseline characteristics of myocarditis patients with preserved EF and the healthy volunteers were perfectly comparable, except for the LV mass index and T1 and T2 mapping values (p < 0.001). The results of the interobserver variability in the 2D and 3D LV CMR FT myocardial strain analysis were p > 0.42, ICC > 0.80 and η2 > 0.98. There was no statistical difference in 2D and 3D global radial, circumferential and longitudinal strain peak (%) and both systolic and diastolic strain rate (1/s) between acute myocarditis with preserved EF and healthy volunteers (all p = ns). There were no difference in 2D and 3D global radial, circumferential and longitudinal strain peak and both systolic and diastolic strain rate of the LV between acute myocarditis patients with preserved ejection fraction and healthy volunteers.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Giulia Benedetti
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Fabio Bioletto
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giovanni Peretto
- Vita Salute San Raffaele University, Milan, Italy
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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Faletti R, Gatti M, Bergamasco L, Bertello C, Bonamini R, Capitolo L, Cesarani F, Ferroni F, Imazio M, Gaita F, Fonio P. "Infarct-like" myocarditis: can the clinical presentation predict results of cardiovascular magnetic resonance examination? Minerva Med 2019; 110:86-88. [PMID: 30667207 DOI: 10.23736/s0026-4806.18.05624-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Riccardo Faletti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy -
| | | | - Claudio Bertello
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | | | - Leonardo Capitolo
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
| | | | - Francesca Ferroni
- Division of Pediatric Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Imazio
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Institute, University of Turin, Turin, Italy
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15
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Diagnostic Accuracy of Cardiovascular Magnetic Resonance in Acute Myocarditis: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2018; 11:1583-1590. [PMID: 29454761 DOI: 10.1016/j.jcmg.2017.12.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this systematic review was to explore the diagnostic accuracy of various cardiovascular magnetic resonance (CMR) index tests for the diagnosis of acute myocarditis in adult patients. BACKGROUND Acute myocarditis remains one of the most challenging diagnoses in cardiology. CMR has emerged as the diagnostic tool of choice to detect acute myocardial injury and necrosis in patients with suspected myocarditis. METHODS We considered all diagnostic cohort and case-control studies. We searched MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science up to April 21, 2017. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to assess the quality of included studies. PROSPERO registration number CRD42017055778 was used. RESULTS Twenty-two studies were included in the systematic review. Because significant heterogeneity exists among the studies, we only present hierarchical receiver operator curves. The areas under the curve (AUC) for each index test were for T1 mapping 0.95 (95% confidence interval [CI]: 0.93 to 0.97), for T2 mapping 0.88 (95% CI: 0.85 to 0.91), for extracellular volume fraction (ECV) 0.81 (95% CI: 0.78 to 0.85), for increased T2 ratio/signal 0.80 (95% CI: 0.76 to 0.83), for late gadolinium enhancement (LGE) 0.87 (95% CI: 0.84 to 0.90), for early gadolinium enhancement (EGE) 0.78 (95% CI: 0.74 to 0.81), and for the Lake Louise criteria (LLC) 0.81 (95% CI: 0.77 to 0.84). Native T1 mapping had superior diagnostic accuracy across all index tests. The AUC of T2 mapping was greater than the AUC of increased T2 ratio/signal and EGE, whereas ECV showed no superiority compared with other index tests. LGE had better diagnostic accuracy compared with the classic CMR index tests, similar accuracy with T2 mapping and ECV, and only T1 mapping surpassed it. CONCLUSIONS Novel CMR mapping techniques provide high diagnostic accuracies for the diagnosis of acute myocarditis and constitute promising successors of the classic elements of the LLC for routine diagnostic protocols.
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