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Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults—towards identification of myocardial inflammation

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Abstract

Objective

To assess active myocardial inflammation by cardiovascular magnetic resonance (CMR) and endomyocardial biopsy (EMB) amongst adult patients with dilated cardiomyopathy (DCM).

Methods

We evaluated 23 adults with chronic DCM, who had successfully undergone both CMR and EMB within 3.5 ± 2.6 days. EMB was considered the gold standard. CMR assessment of myocardial inflammation used the following parameters as recommended by the recently published “Lake Louise Criteria”: global myocardial oedema, global relative enhancement (RE), and late gadolinium enhancement (LGE). According to “Lake Louise Criteria”, myocardial inflammation was diagnosed if two or more of the three above-mentioned parameters were positive.

Results

Myocardial inflammation was confirmed by immunohistology in 12 patients (52.2%). Sensitivity, specificity, and diagnostic accuracy of CMR to detect immunohistologically confirmed myocardial inflammation were 75.0%, 72.7%, and 73.9%, respectively. Sensitivity, specificity, and diagnostic accuracy of the individual CMR parameters to detect myocardial inflammation were as follows: global myocardial oedema, 91.7%, 81.8%, and 87.0%, respectively; global RE, 58.3%, 63.6%, and 60.9%, respectively; LGE, 58.3%, 45.4%, and 52.2%, respectively.

Conclusion

Global myocardial oedema was identified as a promising CMR parameter for assessment of myocardial inflammation in patients with DCM. In these patients, global myocardial oedema yielded superior diagnostic performance compared to “Lake Louise Criteria”.

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Acknowledgements

The study was supported by DFG SFB TR19 B3 to Antje Voigt. A. V. and T. E. contributed equally to this study.

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Authors and Affiliations

  1. Department of Cardiology, Campus Mitte, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany

    Antje Voigt, Mark Beling & Karl Stangl

  2. Department of Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Thomas Elgeti, Tahir Durmus, Merve Ece Idiz, Rene Schilling, Matthias Taupitz & Moritz Wagner

  3. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada

    Craig Butler

  4. Department of Molecular Pathology, University Hospital, 72076, Tübingen, Germany

    Karin Klingel & Reinhard Kandolf

  5. Department of Radiology, Asklepios Klinik St. Georg, 20099, Hamburg, Germany

    Dietmar Kivelitz

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  1. Antje Voigt
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Correspondence to Moritz Wagner.

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Voigt, A., Elgeti, T., Durmus, T. et al. Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults—towards identification of myocardial inflammation. Eur Radiol 21, 925–935 (2011). https://doi.org/10.1007/s00330-010-1985-2

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  • DOI: https://doi.org/10.1007/s00330-010-1985-2

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