Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis

医学 心肌炎 心脏病学 内科学 心肌梗塞 急性心肌炎 急性冠脉综合征 射血分数 肌钙蛋白 磁共振成像 室性心动过速 放射科 心力衰竭
作者
Pierre Monney,Neha Sekhri,Thomas Burchell,Charles Knight,Ceri Davies,Andrew Deaner,Michael Sheaf,Suhail Baithun,Steffen E. Petersen,Andrew Wragg,A. Jain,Mark Westwood,Peter Mills,Anthony Mathur,Saidi A. Mohiddin
出处
期刊:Heart [BMJ]
卷期号:97 (16): 1312-1318 被引量:129
标识
DOI:10.1136/hrt.2010.204818
摘要

Background

In patients presenting with acute cardiac symptoms, abnormal ECG and raised troponin, myocarditis may be suspected after normal angiography.

Aims

To analyse cardiac magnetic resonance (CMR) findings in patients with a provisional diagnosis of acute coronary syndrome (ACS) in whom acute myocarditis was subsequently considered more likely.

Methods and results

79 patients referred for CMR following an admission with presumed ACS and raised serum troponin in whom no culprit lesion was detected were studied. 13% had unrecognised myocardial infarction and 6% takotsubo cardiomyopathy. The remainder (81%) were diagnosed with myocarditis. Mean age was 45±15 years and 70% were male. Left ventricular ejection fraction (EF) was 58±10%; myocardial oedema was detected in 58%. A myocarditic pattern of late gadolinium enhancement (LGE) was detected in 92%. Abnormalities were detected more frequently in scans performed within 2 weeks of symptom onset: oedema in 81% vs 11% (p<0.0005), and LGE in 100% vs 76% (p<0.005). In 20 patients with both an acute (<2 weeks) and convalescent scan (>3 weeks), oedema decreased from 84% to 39% (p<0.01) and LGE from 5.6 to 3.0 segments (p=0.005). Three patients presented with sustained ventricular tachycardia, another died suddenly 4 days after admission and one resuscitated 7 weeks following presentation. All 5 patients had preserved EF.

Conclusions

Our study emphasises the importance of access to CMR for heart attack centres. If myocarditis is suspected, CMR scanning should be performed within 14 days. Myocarditis should not be regarded as benign, even when EF is preserved.

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