Key result
Multimodality imaging using cardiac MRI and nuclear imaging identified an underlying inflammatory substrate in 3 patients presenting with new-onset arrhythmias and normal standard cardiac exams.
Why the study?
The diagnosis of inflammatory cardiomyopathy remains challenging when arrhythmia is the sole manifestation, where early diagnosis is critical to prevent complications like sudden cardiac death and atrioventricular block.
Does multimodality imaging improve the detection of myocardial inflammation in patients presenting with new-onset arrhythmias compared to standard exams?
Case Report (n=3)
Does multimodality imaging improve the detection of myocardial inflammation in patients presenting with new-onset arrhythmias compared to standard exams?
Multimodality imaging, including cardiac MRI and nuclear imaging, provides incremental diagnostic yield for detecting inflammatory cardiomyopathy in patients presenting with isolated arrhythmias.
Answers are grounded in this paper and cite their sources.
May support multimodality imaging in unexplained arrhythmias; leaves open whether it changes management or outcomes.
Background The diagnosis of inflammatory cardiomyopathy remains challenging in cases presenting with arrhythmia as sole manifestation. An early diagnosis is critical as it may prevent life-threatening complications such as sudden cardiac death and atrioventricular block (AVB). The diagnostic workup of suspected cases includes multimodality imaging that requires an adequate interpretation in order to limit the risk of overdiagnosis. Case summary Herein, we report three cases presenting with various new-onset arrhythmias. The first patient was admitted for a third-degree AVB. The second patient suffered from a supraventricular tachycardia which degenerated into ventricular fibrillation. The third case was investigated for symptomatic premature ventricular complexes. No apparent heart disease was observed on standard exams (clinical, biological examinations, and echocardiography). However, cardiac magnetic resonance imaging (MRI) and nuclear imaging (68Ga-DOTATOC and/or 18F-FDG PET/CT) suggested an inflammatory substrate that seemed to correlate with the arrhythmic phenotype. Cardiac inflammation disappeared on immunotherapy for the first case and spontaneously for the third case. Discussion These cases emphasize the incremental diagnostic yield of multimodality imaging to highlight myocardial inflammation. Nuclear imaging modalities may complement MRI by enabling the detection of active inflammation. The 18F-FDG PET/CT is well established for the diagnosis of cardiac sarcoidosis but its role remains to be clarified for the diagnosis of myocarditis. An alternative radiotracer, 68Ga-DOTATOC, appears promising by overcoming the main limitation of 18F-FDG but its specificity is not yet well established. The role of functional investigations is discussed as well as the benefit of immunosuppressive treatments.
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Haddad et al. (2021) conducted a case report in Inflammatory cardiomyopathy presenting with arrhythmia (n=3). Multimodality imaging (cardiac MRI and nuclear imaging) was evaluated on Detection of inflammatory substrate. Multimodality imaging using cardiac MRI and nuclear imaging identified an underlying inflammatory substrate in 3 patients presenting with new-onset arrhythmias and normal standard cardiac exams.
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