Myocarditis as a precipitating factor for heart failure: Evaluation and 1-year follow-up using cardiovascular magnetic resonance and endomyocardial biopsy

Sophie Mavrogeni, Costas Spargias, Costas Bratis, Genovefa Kolovou, Vyron Markussis, Evangelia Papadopoulou, Pantelis Constadoulakis, Miltiadis Papadimitropoulos, Marouso Douskou, Gregory Pavlides, Denis Cokkinos

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Aims The aim of this study was to evaluate myocarditis as a precipitating factor for heart failure using cardiovascular magnetic resonance (CMR) and endomyocardial biopsyMethods and resultsEighty-five patients with suspected myocarditis and 20 controls were evaluated. Seventy-one patients with positive CMR were referred for endomyocardial biopsy and re-evaluation after 1 year. Cardiovascular magnetic resonance was performed using STIR T2-weighted (T2W), early T1-weighted (EGE), and late gadolinium-enhanced (LGE) images. Immunohistological and polymerase chain reaction (PCR) analysis of myocardial specimens was employed.In patients with myocarditis, T2 and EGE were increased compared with controls (2.6 ± 0.9 vs. 1.57 ± 0.13, P < 0.001 and 7.9 ± 5.5 vs. 3.59 ± 0.08, P < 0.001, respectively). Late gadolinium enhancement was found in all myocarditis patients. Endomyocardial biopsy performed in 50 of 71 patients with positive CMR showed positive immunohistology in 48 and presence of infectious genomes in 80 (mainly Chlamydia, Herpes, and Parvovirus B19). Left ventricular ejection fraction (LVEF) was significantly decreased compared with controls (47.7 ± 19.2 vs. 64 ± 0.2, P < 0.001). After 1 year, CMR showed normalization of T2 and EGE, and decreased LGE. Left ventricular ejection fraction increased in 36.5 of patients, remained stable in 56.5 and decreased in 7 of patients, in whom biopsy showed persistence of the initial infective agents. A negative correlation was identified between EGE, LGE, and LVEF. Patients with positive biopsies had lower LVEFs. Conclusion In a Greek population with myocarditis, Chlamydia with viruses was a common finding. Cardiovascular magnetic resonance and PCR proved useful for the detection of myocarditis; EGE and LGE had the best correlation for the development of heart failure. Persistence of the initially detected infective agents was identified in patients who deteriorated further. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)830-837
Number of pages8
JournalEuropean Journal of Heart Failure
Issue number8
StatePublished - Aug 2011
Externally publishedYes


  • Biopsy
  • Chlamydia
  • Coronary artery disease
  • Heart failure
  • Magnetic resonance imaging
  • Myocarditis
  • Polymerase chain reaction
  • Viruses

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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