What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome with no coronary stenosis (n=27). Intervention: Cardiac MRI with delayed contrast enhancement (DCE). Primary outcome: Subepicardial DCE pattern typical of acute myocarditis.

What question did this study set out to answer?

To prospectively evaluate cardiac MRI with delayed contrast enhancement for identifying active myocarditis in patients presenting with acute coronary syndrome and unobstructed coronary arteries.

April 24, 2007Journal of Magnetic Resonance Imaging

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

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Key result

Cardiac MRI with delayed contrast enhancement identified a subepicardial pattern typical of acute myocarditis in 44% of patients presenting with ACS and no coronary stenosis.

Why the study?

Can cardiac MRI with delayed contrast enhancement identify active myocarditis in patients presenting with acute coronary syndrome but no coronary stenosis?

Population

27 consecutive patients presenting with acute coronary syndrome but no coronary stenosis, mean age 45 +/- 17…

Design

Cohort

Follow-up

8 +/- 5 months

Authors

ACAndreï CodreanuInserm MAMichaël Angioı̈Interventional Cardiology GÉGérard ÉthevenotCentre Hospitalier Régional et Universitaire de Nancy

Discussion

Member takes

Implication

May support CMR differentiation of myocarditis in ACS without stenosis; leaves open management impact and need for prospective validation.

Key Points

To prospectively evaluate cardiac MRI with delayed contrast enhancement for identifying active myocarditis in patients presenting with acute coronary syndrome and unobstructed coronary arteries.
Assessed 27 consecutive patients (mean age 45 ± 17 years; 14 male) presenting with acute coronary syndrome (chest pain and positive troponin-I) but no coronary stenosis.
Performed cardiac MRI (SSFP and inversion-recovery sequences) at baseline (9 ± 7 days post-onset) and at 8 ± 5 months follow-up (N = 19), alongside rest sestamibi-gated SPECT.
A subepicardial delayed contrast enhancement (DCE) pattern typical of myocarditis was identified in 44% (12/27) of patients, while an ischemic DCE pattern was present in 44% (12/27).
Patients with subepicardial DCE exhibited higher C-reactive protein (38 ± 32 vs. 14 ± 24 mg/mL; P = 0.04), lower Framingham cardiovascular risk (3 ± 3% vs. 9 ± 5%; P < 0.001), and fewer SPECT perfusion defects (17% vs. 73%; P = 0.01).
Myocarditis patients had larger baseline left ventricular end-diastolic volumes (77 ± 16 vs. 64 ± 10 mL/m²; P = 0.02) and greater DCE area regression at follow-up (-65 ± 17% vs. -18 ± 23%; P = 0.002).

Study Design

Type

Observational (n=27)

Structured PICO

Can cardiac MRI with delayed contrast enhancement identify active myocarditis in patients presenting with acute coronary syndrome but no coronary stenosis?

Population

27 consecutive patients presenting with acute coronary syndrome and no coronary stenosis, evaluated with cardiac MRI at baseline and followed for a mean of 8 months.

Exposure

Cardiac MRI with delayed contrast enhancement (DCE) performed 9 +/- 7 days after pain onset and 8 +/- 5 months later.

Outcome

Detection of subepicardial DCE pattern typical of acute myocarditis versus ischemic DCE pattern.surrogate

Cardiac MRI with delayed contrast enhancement can effectively differentiate acute myocarditis from ischemic injury in patients presenting with ACS and normal coronary arteries.

Cite This Study

Codreanu et al. (2007) conducted an observational in Acute coronary syndrome with no coronary stenosis (n=27). Cardiac MRI with delayed contrast enhancement (DCE) was evaluated on Subepicardial DCE pattern typical of acute myocarditis. Cardiac MRI with delayed contrast enhancement identified a subepicardial pattern typical of acute myocarditis in 44% of patients presenting with ACS and no coronary stenosis.

synapsesocial.com/papers/6a962c5c73e5eba5f7baba0c https://doi.org/10.1002/jmri.20897

Topics

Myocarditis

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Implication

May support CMR differentiation of myocarditis in ACS without stenosis; leaves open management impact and need for prospective validation.

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

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