TY - JOUR
T1 - Evaluation of myocarditis in a pediatric population using cardiovascular magnetic resonance and endomyocardial biopsy
AU - Mavrogeni, Sophie
AU - Bratis, Konstantinos
AU - Georgakopoulos, Dimitrios
AU - Karanasios, Evangelos
AU - Kolovou, Genovefa
AU - Pavlides, Gregory
AU - Papadopoulos, George
N1 - Publisher Copyright:
© 2011 Elsevier Ireland Ltd. All rights reserved.
PY - 2012/10/18
Y1 - 2012/10/18
N2 - Objectives To evaluate myocarditis in a pediatric population using cardiovascular magnetic resonance (CMR) and endomyocardial biopsy. Methods Twenty suspected for myocarditis patients aged 8-16 years and 20 controls were evaluated. CMR was performed using STIR T2-weighted (T2W), early T1-weighted (EGE) and late gadolinium-enhanced images (LGE). Immunohistologic and polymerase chain reaction (PCR) analysis of myocardial specimens were employed in 8/16, who fulfilled the criteria for myocarditis according to clinical and CMR findings. Results Typical clinical, ECG and echocardiographic presentation were identified in 10/16. Troponine I was positive only in 3/16 patients. T2 and EGE in myocarditis were increased compared to controls (2.35 ± 0.5 vs. 1.57 ± 0.13, p < 0.001 and 8.5 ± 3 vs. 3.59 ± 0.08, p < 0.001, respectively). LGE was found only in 10/16 patients. Endomyocardial biopsy, performed in 8/16 patients with positive CMR, showed positive immunohistology in 2/8 and presence of viral genomes in 6/8 (Herpes, Parvo B19 and Epstein-Barr). Left ventricular ejection fraction (LVEF) was significantly decreased compared to controls (49.6 ± 14.8 vs. 64 ± 0.2, p < 0.001). After 6 months, CMR showed normalization of T2, EGE and decreased/or absent LGE. LVEF was normal in all, except two, who remained with low LVEF but in a stable clinical condition. Conclusions In a small Greek pediatric population with myocarditis, CMR proved useful for the detection of myocarditis, especially in those with negative troponine and mild clinical presentation.
AB - Objectives To evaluate myocarditis in a pediatric population using cardiovascular magnetic resonance (CMR) and endomyocardial biopsy. Methods Twenty suspected for myocarditis patients aged 8-16 years and 20 controls were evaluated. CMR was performed using STIR T2-weighted (T2W), early T1-weighted (EGE) and late gadolinium-enhanced images (LGE). Immunohistologic and polymerase chain reaction (PCR) analysis of myocardial specimens were employed in 8/16, who fulfilled the criteria for myocarditis according to clinical and CMR findings. Results Typical clinical, ECG and echocardiographic presentation were identified in 10/16. Troponine I was positive only in 3/16 patients. T2 and EGE in myocarditis were increased compared to controls (2.35 ± 0.5 vs. 1.57 ± 0.13, p < 0.001 and 8.5 ± 3 vs. 3.59 ± 0.08, p < 0.001, respectively). LGE was found only in 10/16 patients. Endomyocardial biopsy, performed in 8/16 patients with positive CMR, showed positive immunohistology in 2/8 and presence of viral genomes in 6/8 (Herpes, Parvo B19 and Epstein-Barr). Left ventricular ejection fraction (LVEF) was significantly decreased compared to controls (49.6 ± 14.8 vs. 64 ± 0.2, p < 0.001). After 6 months, CMR showed normalization of T2, EGE and decreased/or absent LGE. LVEF was normal in all, except two, who remained with low LVEF but in a stable clinical condition. Conclusions In a small Greek pediatric population with myocarditis, CMR proved useful for the detection of myocarditis, especially in those with negative troponine and mild clinical presentation.
KW - Biopsy
KW - Magnetic resonance imaging
KW - Myocarditis
KW - Polymerase chain reaction
KW - Viruses
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U2 - 10.1016/j.ijcard.2011.04.019
DO - 10.1016/j.ijcard.2011.04.019
M3 - Article
C2 - 21561672
AN - SCOPUS:84878227583
SN - 0167-5273
VL - 160
SP - 192
EP - 195
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 3
ER -