Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T
ABSTRACT: Aims: Myocardial inflammation is increasingly detected noninvasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or markers of myocardial injury, high-sensitive cardiac troponin (hs-cTnT) in patients with clini...
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Elsevier
2024-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664724011141 |
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| author | Hafisyatul Zainal Andreas Rolf Hui Zhou Moises Vasquez Felicitas Escher Till Keller Mariuca Vasa-Nicotera Andreas M. Zeiher Heinz-Peter Schultheiss Eike Nagel Valentina O. Puntmann |
| author_facet | Hafisyatul Zainal Andreas Rolf Hui Zhou Moises Vasquez Felicitas Escher Till Keller Mariuca Vasa-Nicotera Andreas M. Zeiher Heinz-Peter Schultheiss Eike Nagel Valentina O. Puntmann |
| author_sort | Hafisyatul Zainal |
| collection | DOAJ |
| description | ABSTRACT: Aims: Myocardial inflammation is increasingly detected noninvasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or markers of myocardial injury, high-sensitive cardiac troponin (hs-cTnT) in patients with clinically suspected viral myocarditis is incompletely understood. Methods: Prospective multicenter study of consecutive patients with clinically suspected myocarditis who underwent blood testing for hs-cTnT, CMR, and EMB as a part of diagnostic workup. EMB was considered positive based on immunohistological criteria in line with the European Society of Cardiology (ESC) definitions. CMR diagnoses employed tissue mapping using sequence-specific cut-off for native T1 and T2 mapping; active inflammation was defined as T1 ≥2 standard deviation (SD) and T2 ≥2 SD above the mean of normal range. Hs-cTnT of greater than 13.9 ng/L was considered significant. Results: A total of 114 patients (age (mean ± SD) 54 ± 16, 65% males) were included, of which 79 (69%) had positive EMB criteria, 64 (56%) CMR criteria, and a total of 58 (51%) positive troponin. Agreement between EMB and CMR diagnostic criteria was poor (CMR vs ESC: area under the curve (AUC): 0.51 (0.39–0.62)). The agreement between a significant hs-cTnT rise and CMR-based diagnosis of myocarditis was good (AUC: 0.84 (0.68–0.92); p < 0.001), but poor for EMB (0.50 (0.40–0.61). Hs-cTnT was significantly associated with native T1 and T2, high-sensitive C-reactive protein, and N-terminal pro-hormone brain natriuretic peptide (r = 0.37, r = 0.35, r = 0.30, r = 0.25; p < 0.001), but not immunohistochemical criteria or viral presence. Conclusion: In clinically suspected viral myocarditis, all diagnostic approaches reflect the pathophysiological elements of myocardial inflammation; however, the differing underlying drivers only partially overlap. The EMB and CMR diagnostic algorithms are neither interchangeable in terms of interpretation of myocardial inflammation nor in their relationship with myocardial injury. |
| format | Article |
| id | doaj-art-1131ccc7f72748dbba522bf38d14c4d4 |
| institution | Kabale University |
| issn | 1097-6647 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-1131ccc7f72748dbba522bf38d14c4d42024-12-16T05:34:48ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472024-01-01262101087Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin THafisyatul Zainal0Andreas Rolf1Hui Zhou2Moises Vasquez3Felicitas Escher4Till Keller5Mariuca Vasa-Nicotera6Andreas M. Zeiher7Heinz-Peter Schultheiss8Eike Nagel9Valentina O. Puntmann10Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, Universiti Teknologi MARA (UiTM), Selangor, MalaysiaDepartment of Cardiology, Kerckhoff Clinic, University Giessen, Bad Nauheim, GermanyInstitute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, XiangYa Hospital, Central South University, Changsha, Hunan, ChinaInstitute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Cardiology Department, Enrique Baltodano Briceño Hospital, Liberia, Costa RicaInstitute for Cardiac Diagnostic and Therapy, Berlin, GermanyDepartment of Cardiology, Kerckhoff Clinic, University Giessen, Bad Nauheim, GermanyDepartment of Cardiac Regeneration, Goethe University Frankfurt, Frankfurt am Main, GermanyDepartment of Cardiac Regeneration, Goethe University Frankfurt, Frankfurt am Main, GermanyInstitute for Cardiac Diagnostic and Therapy, Berlin, GermanyInstitute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, GermanyInstitute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Corresponding author. Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany.ABSTRACT: Aims: Myocardial inflammation is increasingly detected noninvasively by tissue mapping with cardiovascular magnetic resonance (CMR). Intraindividual agreement with endomyocardial biopsy (EMB) or markers of myocardial injury, high-sensitive cardiac troponin (hs-cTnT) in patients with clinically suspected viral myocarditis is incompletely understood. Methods: Prospective multicenter study of consecutive patients with clinically suspected myocarditis who underwent blood testing for hs-cTnT, CMR, and EMB as a part of diagnostic workup. EMB was considered positive based on immunohistological criteria in line with the European Society of Cardiology (ESC) definitions. CMR diagnoses employed tissue mapping using sequence-specific cut-off for native T1 and T2 mapping; active inflammation was defined as T1 ≥2 standard deviation (SD) and T2 ≥2 SD above the mean of normal range. Hs-cTnT of greater than 13.9 ng/L was considered significant. Results: A total of 114 patients (age (mean ± SD) 54 ± 16, 65% males) were included, of which 79 (69%) had positive EMB criteria, 64 (56%) CMR criteria, and a total of 58 (51%) positive troponin. Agreement between EMB and CMR diagnostic criteria was poor (CMR vs ESC: area under the curve (AUC): 0.51 (0.39–0.62)). The agreement between a significant hs-cTnT rise and CMR-based diagnosis of myocarditis was good (AUC: 0.84 (0.68–0.92); p < 0.001), but poor for EMB (0.50 (0.40–0.61). Hs-cTnT was significantly associated with native T1 and T2, high-sensitive C-reactive protein, and N-terminal pro-hormone brain natriuretic peptide (r = 0.37, r = 0.35, r = 0.30, r = 0.25; p < 0.001), but not immunohistochemical criteria or viral presence. Conclusion: In clinically suspected viral myocarditis, all diagnostic approaches reflect the pathophysiological elements of myocardial inflammation; however, the differing underlying drivers only partially overlap. The EMB and CMR diagnostic algorithms are neither interchangeable in terms of interpretation of myocardial inflammation nor in their relationship with myocardial injury.http://www.sciencedirect.com/science/article/pii/S1097664724011141MyocarditisDiagnosisEndomyocardial biopsyImmunohistologyCardiovascular magnetic resonanceMyocardial mapping |
| spellingShingle | Hafisyatul Zainal Andreas Rolf Hui Zhou Moises Vasquez Felicitas Escher Till Keller Mariuca Vasa-Nicotera Andreas M. Zeiher Heinz-Peter Schultheiss Eike Nagel Valentina O. Puntmann Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T Journal of Cardiovascular Magnetic Resonance Myocarditis Diagnosis Endomyocardial biopsy Immunohistology Cardiovascular magnetic resonance Myocardial mapping |
| title | Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T |
| title_full | Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T |
| title_fullStr | Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T |
| title_full_unstemmed | Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T |
| title_short | Comparison of diagnostic algorithms in clinically suspected viral myocarditis: Agreement between cardiovascular magnetic resonance, endomyocardial biopsy, and troponin T |
| title_sort | comparison of diagnostic algorithms in clinically suspected viral myocarditis agreement between cardiovascular magnetic resonance endomyocardial biopsy and troponin t |
| topic | Myocarditis Diagnosis Endomyocardial biopsy Immunohistology Cardiovascular magnetic resonance Myocardial mapping |
| url | http://www.sciencedirect.com/science/article/pii/S1097664724011141 |
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