May 12, 1998Circulation
Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis
Key result
Contrast media-enhanced MRI demonstrated significantly higher global relative signal enhancement in patients with acute myocarditis on day 2 compared to healthy volunteers (4.8 vs 2.5; P<.0001).
Why the study?
Does contrast media-enhanced MRI visualize myocardial changes over time in patients with acute viral myocarditis compared to volunteers?
Population
19 patients with acute viral myocarditis and 18 volunteers.
Comparison
Contrast media-enhanced MRI performed on days 2… vs 18 healthy volunteers.
Design
Cohort
Follow-up
84 days
Authors
Discussion
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Implication
May support noninvasive detection of myocardial inflammation in acute myocarditis; leaves open its value for serial monitoring or clinical decision-making.
Key Points
- To determine whether contrast media-enhanced magnetic resonance imaging (MRI) can visualize the localization, activity, and temporal course of myocardial inflammation in acute viral myocarditis.
- Assessed 44 consecutive patients with acute myocarditis symptoms, enrolling 19 who met clinical, electrocardiographic, biomarker, and scintigraphic criteria, alongside 18 healthy volunteers.
- Performed ECG-triggered, T1-weighted MRI before and after 0.1 mmol/kg gadolinium administration on days 2, 7, 14, 28, and 84 following symptom onset.
- Calculated global relative signal enhancement of the left ventricular myocardium normalized to skeletal muscle across each follow-up time point.
- Global relative enhancement was significantly elevated in patients versus controls on day 2 (4.8±0.3 vs 2.5±0.2, P<.0001), day 7 (4.7±0.5, P<.0001), day 14 (4.6±0.5, P<.0002), and day 28 (3.9±0.4, P=.009), returning toward baseline by day 84 (3.1±0.3, P=NS).
- Myocardial enhancement manifested focally on day 2 and transitioned into a diffuse pattern during the first 2 weeks, with values remaining elevated in patients with ongoing active disease.
Study Design
Type
Observational (n=37)
Structured PICO
Does contrast media-enhanced MRI visualize myocardial changes over time in patients with acute viral myocarditis compared to volunteers?
P
Population
19 patients with acute viral myocarditis (ECG changes, reduced myocardial function, elevated creatine kinase, positive troponin T, serological evidence for acute viral infection, exclusion of coronary heart disease, and positive antimyosin scintigraphy) and 18 volunteers.
I
Intervention
Contrast media-enhanced MRI (0.1 mmol/kg gadolinium, ECG-triggered, T1-weighted images) performed on days 2, 7, 14, 28, and 84 after symptom onset.
C
Comparator
18 healthy volunteers.
O
Outcome
Global relative signal enhancement of the left ventricular myocardium related to skeletal muscle.surrogate
Main Result
Absolute Event Rate: 4.8% vs 2.5%
p-value: p=<.0001
Contrast-enhanced MRI can noninvasively visualize the localization, activity, and extent of inflammation in acute myocarditis, demonstrating an evolution from focal to diffuse involvement over the first 2 weeks.
Cite This Study
Friedrich et al. (1998) conducted an observational in Acute viral myocarditis (n=37). Contrast media-enhanced MRI vs. Healthy volunteers was evaluated on Global relative signal enhancement of the left ventricular myocardium related to skeletal muscle on day 2 (p=<.0001). Contrast media-enhanced MRI demonstrated significantly higher global relative signal enhancement in patients with acute myocarditis on day 2 compared to healthy volunteers (4.8 vs 2.5; P<.0001).