Why the study?
Myopathies affect both cardiac and skeletal muscle, prompting investigation into the prevalence of cardiac inflammation using CMR in symptomatic patients with normal echocardiography.
Does cardiovascular magnetic resonance detect and differentiate myocardial inflammation in symptomatic patients with genetic and inflammatory myopathies who have normal echocardiography?
Does cardiovascular magnetic resonance detect and differentiate myocardial inflammation in symptomatic patients with genetic and inflammatory myopathies who have normal echocardiography?
CMR tissue characterization can detect and differentiate acute versus chronic low-grade myocardial inflammation in symptomatic myopathy patients with normal echocardiograms.
CMR T2-criteria may differentiate myocardial involvement in genetic versus inflammatory myopathies; hypothesis-generating and requires prospective validation before clinical use.
Introduction. Myopathies are heterogeneous neuromuscular diseases of genetic and/or inflammatory etiology that affect both cardiac and skeletal muscle. We investigated the prevalence of cardiac inflammation in patients with myopathies, cardiovascular symptoms, and normal echocardiography using cardiovascular magnetic resonance (CMR). Methods. We prospectively evaluated 51 patients with various genetic (n = 23) and inflammatory (n = 28) myopathies (median age, IQR: 12 (11–15) years, 22% girls; 61 (55–65) years, 46% women, respectively) and compared their CMR findings to corresponding age- and sex-matched controls (n = 21 and 20, respectively) and to each other. Results. Patients with genetic myopathy had similar biventricular morphology and function to healthy controls but showed higher late gadolinium enhancement (LGE), native T1 mapping, extracellular volume fraction (ECV), and T2 mapping values. Collectively, 22 (95.7%) patients with genetic myopathy had a positive T1-criterion and 3 (13.0%) had a positive T2-criterion according to the updated Lake Louise criteria. Compared with healthy controls, patients with inflammatory myopathy showed preserved left ventricular (LV) function and reduced LV mass, while all CMR-derived tissue characterization indices were significantly higher (p < 0.001 for all). All patients had a positive T1-criterion, and 27 (96.4%) had a positive T2-criterion. A positive T2-criterion or T2-mapping > 50 ms could discriminate between patients with genetic and inflammatory myopathies with a sensitivity of 96.4% and a specificity of 91.3% (AUC = 0.9557). Conclusions. The vast majority of symptomatic patients with inflammatory myopathies and normal echocardiography show evidence of acute myocardial inflammation. In contrast, acute inflammation is rare in patients with genetic myopathies, who show evidence of chronic low-grade inflammation.
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Markousis‐Mavrogenis et al. (2023) studied this question.
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