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

Victor Rodrigues Ribeiro Ferreira; Maria Christiane Valéria Braga Braile-Sternieri; Eliana Migliorini Mustafa; Sofia Braile Sabino; Cibele Olegário Vianna Queiroz; Bethina Canaroli Sbardellini; Giovanni Braile Sternieri; Luiza Braile Verdi; Idiberto José Zotarelli Filho; Domingo Marcolino Braile

doi:doi:10.11648/j.plm.20190302.11

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

Victor Rodrigues Ribeiro Ferreira, Maria Christiane Valéria Braga Braile-Sternieri, Eliana Migliorini Mustafa, Sofia Braile Sabino, Cibele Olegário Vianna Queiroz, Bethina Canaroli Sbardellini, Giovanni Braile Sternieri, Luiza Braile Verdi, Idiberto José Zotarelli Filho, Domingo Marcolino Braile

Published in Pathology and Laboratory Medicine (Volume 3, Issue 2)

Received: 5 September 2019 Accepted: 4 October 2019 Published: 2 December 2019

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

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.

Published in	Pathology and Laboratory Medicine (Volume 3, Issue 2)
DOI	10.11648/j.plm.20190302.11
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), 2019. Published by Science Publishing Group

Keywords

Myocarditis, Cardiac Magnetic Resonance, Strain Echocardiography, Diagnosis

References

[1]	Eyer-Silva WA, Rosa da Silva GA, da Cunha Pinto JF. Acute myocarditis after switch to dolutegravir: a reminder of potential toxicity of integrase inhibitor-including HAART. AIDS. 2019 Nov 1; 33 (13): 2105-2107. doi: 10.1097/QAD.0000000000002322.
[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.
[4]	Tornvall P, Brolin EB, Caidahl K, et al. The value of a new cardiac magnetic resonance imaging protocol in Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)—A case-control study using historical controls from a previous study with similar inclusion criteria. BMC Cardiovasc Disord 2017; 17: 199.
[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.
[8]	Lurz P, Luecke C, Eitel I, et al. Comprehensive cardiac magnetic resonance imaging in patients with suspected myocarditis: The MyoRacerTrial. J Am Coll Cardiol 2016; 67: 1800–1811.
[9]	Del Castlho JM and Herszkowicz N. Strain bidimensional (X-Strain): utlização do método para avaliação de cardiopatas. Rev Bras Ecocardiogr. 2008; 21: 29-25.
[10]	Delgado V, Mollema SA, Ypenburg C, Tops LF, van der Wall EE, Schalij MJ and Bax JJ. Relaton between global lef ventricular longitudinal strain assessed with novel automated functon imaging and biplane lef ventricular ejecton fracton in patents with coronary artery disease. J Am Soc Echocardiogr. 2008; 21: 1244-50.
[11]	Lo Q, Hee L, Batumalai V, Allman C, MacDonald P, Lonergan D, Delaney GP and Thomas L. Strain Imaging Detects Dose-Dependent Segmental Cardiac Dysfuncton in the Acute Phase Afer Breast Irradiaton. Int J Radiat Oncol Biol Phys. 2017; 99: 182-190.
[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.
[16]	Angelini A, Calzolari V, Calabrese F, et al. Myocarditis mimicking acute myocardial infarction: Role of endomyocardial biopsy in the differential diagnosis. Heart 2000; 84: 245–250.
[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.
[18]	Cooper LT Jr, Keren A, Sliwa K, Matsumori A, Mensah GA. The global burden of myocarditis. Global Heart 2014; 9: 121–129.
[19]	Haaf P, Buser PT. Map to the future of cardiac magnetic resonance in myocarditis. Eur Heart J Cardiovasc Imaging. 2017 Jul 1; 18 (7): 752-753. doi: 10.1093/ehjci/jex024.
[20]	Hékimian G, Combes A. Myocarditis]. Rev Med Interne. 2017 Aug; 38 (8): 531-538. doi: 10.1016/j.revmed.2016.12.022. Epub 2017 Feb 2.
[21]	Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res. 2016 Feb 5; 118 (3): 496-514. doi: 10.1161/CIRCRESAHA.115.306573.

Cite This Article

Plain Text BibTeX RIS

APA Style

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

Copy | Download

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

Copy | Download

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

Copy | Download

@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://article.sciencepublishinggroup.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}
}

Copy | Download

TY  - JOUR
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  -

Copy | Download

Author Information

Victor Rodrigues Ribeiro Ferreira

Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil
Maria Christiane Valéria Braga Braile-Sternieri

Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil
Eliana Migliorini Mustafa

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

Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil
Cibele Olegário Vianna Queiroz

Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil
Bethina Canaroli Sbardellini

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

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

Domingo Braile Institute, Institute of Cardiology, Sao Jose do Rio Preto, Brazil
Idiberto José Zotarelli Filho

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

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

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

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

Copy | Download

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

Copy | Download

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

Copy | Download

@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://article.sciencepublishinggroup.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}
}

Copy | Download

TY  - JOUR
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  -

Copy | Download