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JACC Cardiovasc Imaging. 2015 Jan;8(1):37-46. doi: 10.1016/j.jcmg.2014.07.016. Epub 2014 Dec 10.

Native T1 in discrimination of acute and convalescent stages in patients with clinical diagnosis of myocarditis: a proposed diagnostic algorithm using CMR.

Author information

1
Cardiovascular Imaging Department, Division of Imaging Sciences, King's College London, London, United Kingdom.
2
St. Vincent's Hospital and the Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.
3
Philips Healthcare, Guildford, United Kingdom.
4
Guys and St. Thomas' NHS Trust, London, United Kingdom.
5
Cardiovascular Division, King's College London, London, United Kingdom.
6
Cardiovascular Imaging Department, Division of Imaging Sciences, King's College London, London, United Kingdom. Electronic address: v.puntmann@kcl.ac.uk.

Abstract

OBJECTIVES:

This study investigated whether T1 mapping by cardiac magnetic resonance (CMR) reflects the clinical evolution of disease in myocarditis and supports its diagnosis independently of the disease stages.

BACKGROUND:

Acute viral myocarditis is characterized by a range of intracellular changes due to viral replication and extracellular spill of debris within days of viral infection. Convalescence may be characterized by a chronic low-grade inflammation leading to ventricular remodelling, but also a complete resolution of myocardial changes.

METHODS:

Patients with clinical diagnosis of viral myocarditis (N = 165) underwent routine clinical CMR protocol (1.5- and 3.0-T) for assessment of cardiac function and structure, and tissue characterization with T2-weighted imaging and late gadolinium enhancement. T1 mapping was obtained in a mid-ventricular short-axis slice before and >20 min after administration of 0.2 mmol/kg of gadobutrol.

RESULTS:

Compared with control subjects (n = 40), T1 indexes were increased in patients with myocarditis. Patients with acute symptoms (n = 61) had higher values of T1 indexes compared with patients in clinical convalescence (n = 67). Native T1 is an independent discriminator between health and disease, as well as a discriminator between acute and convalescent stage of the disease. Native T1- was superior to T2-weighted imaging and late gadolinium enhancement with high diagnostic accuracy and positive and negative predictive values. Using pre-defined cutoff values for normal ranges, we demonstrated that acute myocarditis can be independently identified by native T1 of >5 SD above the mean of normal range, whereas convalescence is best defined by either abnormal native T1 (>2 SD) or presence of late gadolinium enhancement. We prospectively tested a new diagnostic algorithm in an independent dataset of patients with clinical diagnosis of myocarditis and achieved similar diagnostic performance.

CONCLUSIONS:

The new diagnostic algorithm using native T1 can reliably discriminate between health and disease and determine the clinical disease stage in patients with a clinical diagnosis of myocarditis.

KEYWORDS:

T1 mapping; cardiac magnetic resonance; myocarditis; native T1

Comment in

PMID:
25499131
DOI:
10.1016/j.jcmg.2014.07.016
[Indexed for MEDLINE]
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