Pathology and Laboratory Medicine

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Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis

Received: 05 September 2019    Accepted: 04 October 2019    Published: 02 December 2019
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Abstract

Introduction: Myocarditis (MC) can result from a variety of infectious and non-infectious causes, and the secondary MC due to viral infection is the most prevalent form. Acute and nonfatal MC, on the other hand, has a more indolent presentation with mortality up to 20.0% in the first year and 55.0% at 11 years based on the initial diagnosis of acute MC. The diagnostic evaluation of MC is done initially through clinical suspicion, together with non-invasive diagnostic methods. In this sense, we highlight the Echocardiography with Strain. Objective: to present the importance of the early diagnosis of myocarditis through the images obtained by the Strain Echocardiography and Cardiac Magnetic Resonance. Case report: The CBB patient, 25 years old, female, with no known diagnosis, reports that two weeks ago the patient had started upper airway infection with partial improvement after specific antimicrobial treatment. The hemogram revealed normocytic and normochromic anemia and leukocytosis with predominance of segmented. C-reactive protein was elevated and markers of myocardial ischemia were also altered. Strain echocardiography revealed segmental alterations of the endomyocardial deformation with reduction of the longitudinal Strain in the middle inferolateral and middle anterolateral segments. Cardiac magnetic resonance revealed late focal mesoepicardial enhancement, of small extension, in the midbasal inferolateral segment, suggestive of MC. Final considerations: In conclusion the study made it possible to know that the early diagnosis of myocarditis through the image obtained by the Strain Echocardiography showed the inflammatory process in the same region observed by cardiac magnetic resonance imaging. This was added to the hemogram, reactive protein, and to the markers of myocardial ischemia.

DOI 10.11648/j.plm.20190302.11
Published in Pathology and Laboratory Medicine (Volume 3, Issue 2, December 2019)
Page(s) 23-27
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Myocarditis, Cardiac Magnetic Resonance, Strain Echocardiography, Diagnosis

References
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[2] Pedrotti P, Pedretti S, Imazio M, Quattrocchi G, Sormani P, Milazzo A, Quarta G. Clinical applications of cardiac magnetic resonance imaging: coronary heart disease, myocarditis, pericardial diseases, arrhythmias, valvular heart disease, congenital heart disease and cardiac masses. G Ital Cardiol (Rome). 2019 Jan; 20 (1): 8-19. doi: 10.1714/3079.30716.
[3] Gannon MP, Schaub E, Grines CL, Saba SG. State of the art: Evaluation and prognostication of myocarditis using cardiac MRI. J Magn Reson Imaging. 2019 Jan 13. doi: 10.1002/jmri.26611.
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[5] Chopra H, Arangalage D, Bouleti C, et al. Prognostic value of the infarctand non-infarct like patterns and cardiovascular magnetic resonance parameters on long-term outcome of patients after acute myocarditis. Int J Cardiol 2016; 212: 63–69.
[6] De Lazzari M, Zorzi A, Baritussio A, et al. Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: Clinical and prognostic implications. J Electrocardiol 2016; 49: 587–595.
[7] Hinojar R, Nagel E, Puntmann VO. T1 mapping in myocarditis—Headway to a new era for cardiovascular magnetic resonance. Expert Rev Cardiovasc Ther 2015; 13: 871–874.
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[12] Mangion K, McComb C, Auger DA, Epstein FH and Berry C. Magnetc Resonance Imaging of Myocardial Strain Afer Acute ST-SegmentElevaton Myocardial Infarcton: A Systematc Review. Circ Cardiovasc Imaging. 2017; 10.
[13] Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E. Braunwald’s heart disease: A textbook of cardiovascular medicine, 10th ed. Philadelphia: Elsevier/Saunders; 2015.
[14] Luetkens JA, Homsi R, Dabir D, et al. Comprehensive cardiac magnetic resonance for short-term follow-up in acute myocarditis. J Am Heart Assoc 2016; 5.
[15] Gupta S, Markham DW, Drazner MH, Mammen PP. Fulminant myocarditis. Nat Clin Pract Cardiovasc Med 2008; 5: 693–706.
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[17] Babu-Narayan SV, McCarthy KP, Ho SY, Magee AG, Kilner PJ, Sheppard MN. Images in cardiovascular medicine. Myocarditis and sudden cardiac death in the young: Extensive fibrosis suggested by cardiovascular magnetic resonance in vivo and confirmed post mortem. Circulation 2007; 116: e122–125.
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Author Information
  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil; Faceres, Medical School of S?o Jose do Rio Preto, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

  • Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil

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    Victor Rodrigues Ribeiro Ferreira, Maria Christiane Valéria Braga Braile-Sternieri, Eliana Migliorini Mustafa, Sofia Braile Sabino, Cibele Olegário Vianna Queiroz, et al. (2019). Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis. Pathology and Laboratory Medicine, 3(2), 23-27. https://doi.org/10.11648/j.plm.20190302.11

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    ACS Style

    Victor Rodrigues Ribeiro Ferreira; Maria Christiane Valéria Braga Braile-Sternieri; Eliana Migliorini Mustafa; Sofia Braile Sabino; Cibele Olegário Vianna Queiroz, et al. Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis. Pathol. Lab. Med. 2019, 3(2), 23-27. doi: 10.11648/j.plm.20190302.11

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    AMA Style

    Victor Rodrigues Ribeiro Ferreira, Maria Christiane Valéria Braga Braile-Sternieri, Eliana Migliorini Mustafa, Sofia Braile Sabino, Cibele Olegário Vianna Queiroz, et al. Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis. Pathol Lab Med. 2019;3(2):23-27. doi: 10.11648/j.plm.20190302.11

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  • @article{10.11648/j.plm.20190302.11,
      author = {Victor Rodrigues Ribeiro Ferreira and Maria Christiane Valéria Braga Braile-Sternieri and Eliana Migliorini Mustafa and Sofia Braile Sabino and Cibele Olegário Vianna Queiroz and Bethina Canaroli Sbardellini and Giovanni Braile Sternieri and Luiza Braile Verdi and Idiberto José Zotarelli Filho and Domingo Marcolino Braile},
      title = {Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis},
      journal = {Pathology and Laboratory Medicine},
      volume = {3},
      number = {2},
      pages = {23-27},
      doi = {10.11648/j.plm.20190302.11},
      url = {https://doi.org/10.11648/j.plm.20190302.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.plm.20190302.11},
      abstract = {Introduction: Myocarditis (MC) can result from a variety of infectious and non-infectious causes, and the secondary MC due to viral infection is the most prevalent form. Acute and nonfatal MC, on the other hand, has a more indolent presentation with mortality up to 20.0% in the first year and 55.0% at 11 years based on the initial diagnosis of acute MC. The diagnostic evaluation of MC is done initially through clinical suspicion, together with non-invasive diagnostic methods. In this sense, we highlight the Echocardiography with Strain. Objective: to present the importance of the early diagnosis of myocarditis through the images obtained by the Strain Echocardiography and Cardiac Magnetic Resonance. Case report: The CBB patient, 25 years old, female, with no known diagnosis, reports that two weeks ago the patient had started upper airway infection with partial improvement after specific antimicrobial treatment. The hemogram revealed normocytic and normochromic anemia and leukocytosis with predominance of segmented. C-reactive protein was elevated and markers of myocardial ischemia were also altered. Strain echocardiography revealed segmental alterations of the endomyocardial deformation with reduction of the longitudinal Strain in the middle inferolateral and middle anterolateral segments. Cardiac magnetic resonance revealed late focal mesoepicardial enhancement, of small extension, in the midbasal inferolateral segment, suggestive of MC. Final considerations: In conclusion the study made it possible to know that the early diagnosis of myocarditis through the image obtained by the Strain Echocardiography showed the inflammatory process in the same region observed by cardiac magnetic resonance imaging. This was added to the hemogram, reactive protein, and to the markers of myocardial ischemia.},
     year = {2019}
    }
    

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    T1  - Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis
    AU  - Victor Rodrigues Ribeiro Ferreira
    AU  - Maria Christiane Valéria Braga Braile-Sternieri
    AU  - Eliana Migliorini Mustafa
    AU  - Sofia Braile Sabino
    AU  - Cibele Olegário Vianna Queiroz
    AU  - Bethina Canaroli Sbardellini
    AU  - Giovanni Braile Sternieri
    AU  - Luiza Braile Verdi
    AU  - Idiberto José Zotarelli Filho
    AU  - Domingo Marcolino Braile
    Y1  - 2019/12/02
    PY  - 2019
    N1  - https://doi.org/10.11648/j.plm.20190302.11
    DO  - 10.11648/j.plm.20190302.11
    T2  - Pathology and Laboratory Medicine
    JF  - Pathology and Laboratory Medicine
    JO  - Pathology and Laboratory Medicine
    SP  - 23
    EP  - 27
    PB  - Science Publishing Group
    SN  - 2640-4478
    UR  - https://doi.org/10.11648/j.plm.20190302.11
    AB  - Introduction: Myocarditis (MC) can result from a variety of infectious and non-infectious causes, and the secondary MC due to viral infection is the most prevalent form. Acute and nonfatal MC, on the other hand, has a more indolent presentation with mortality up to 20.0% in the first year and 55.0% at 11 years based on the initial diagnosis of acute MC. The diagnostic evaluation of MC is done initially through clinical suspicion, together with non-invasive diagnostic methods. In this sense, we highlight the Echocardiography with Strain. Objective: to present the importance of the early diagnosis of myocarditis through the images obtained by the Strain Echocardiography and Cardiac Magnetic Resonance. Case report: The CBB patient, 25 years old, female, with no known diagnosis, reports that two weeks ago the patient had started upper airway infection with partial improvement after specific antimicrobial treatment. The hemogram revealed normocytic and normochromic anemia and leukocytosis with predominance of segmented. C-reactive protein was elevated and markers of myocardial ischemia were also altered. Strain echocardiography revealed segmental alterations of the endomyocardial deformation with reduction of the longitudinal Strain in the middle inferolateral and middle anterolateral segments. Cardiac magnetic resonance revealed late focal mesoepicardial enhancement, of small extension, in the midbasal inferolateral segment, suggestive of MC. Final considerations: In conclusion the study made it possible to know that the early diagnosis of myocarditis through the image obtained by the Strain Echocardiography showed the inflammatory process in the same region observed by cardiac magnetic resonance imaging. This was added to the hemogram, reactive protein, and to the markers of myocardial ischemia.
    VL  - 3
    IS  - 2
    ER  - 

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