The online version of this article (doi:10.1186/1476-7120-10-42) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
ML: study design, collection and analysis of data, conclusions, review of literature and writing the manuscript. VT: analysis and presentation of results, statistical assessment. EP: intellectual input, analysis of data. LC: intellectual input, analysis of data. ZV: study design, analysis of data, discussion of results and conclusions, writing the manuscript and final approval. All authors read and approved the final manuscript.
Until recently acute inflammatory peri-myocardial syndromes have been associated with global rather regional left ventricular (LV) dysfunction. Recent advances in cardiac imaging with echocardiographic techniques and magnetic resonance imaging (MRI) permit comprehensive evaluation of global and regional LV function. Our study was aimed to assess regional LV function in 100 patients with acute perimyocarditis, and correlate these findings with the clinical presentation.
We report on 100 patients with acute perimyocarditis admitted during 2008–2011, in whom LV function was assessed by semi-quantitative wall motion score analysis on conventional echo. Long-term mortality and recurrent hospitalization were also assessed.
Wall motion score in 100 patients with acute perimyocarditis demonstrated a significant predominance of regional wall motion abnormalities in the infero-postero-lateral LV wall. These data correspond well with speckle tracking results of a subgroup of these patients published earlier. Recent MRI data show frequent late enhancement of contrast in the infero-lateral region of the LV in patients with perimyocarditis. These observations were useful in re-classification of our patients into one of the following groups: pure or predominant pericarditis, and pure or predominant myocarditis. Over a mean period of 37 months, there was no mortality. Though recurrent hospitalizations were rather frequent, no significant differences were observed among groups.
Regional wall motion abnormalities in the infero-postero-lateral segments of the LV are frequent in patients with acute perimyocarditis. Detailed echocardiographic examination early in the course of the disease should become a major factor in the clinical differentiation among the various clinical presentations of acute inflammatory peri-myocardial syndromes. The long-term outcome of these patients appears to be benign, though recurrent hospitalizations are not infrequent.
Additional file 1: Video. Mid postero-lateral and mid inferior hypokinesis in the patients with mild myocarditis. (AVI 759 KB)12947_2012_445_MOESM1_ESM.avi
Authors’ original file for figure 112947_2012_445_MOESM2_ESM.tiff
Authors’ original file for figure 212947_2012_445_MOESM3_ESM.doc
Authors’ original file for figure 312947_2012_445_MOESM4_ESM.doc
Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH, Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology: Guidelines on the diagnosis and management of pericardial diseases. The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004, 25 (7): 587-610. CrossRefPubMed
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms, et al: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989, 2: 358-367. CrossRefPubMed
Leitman M, Lysiansky M, Lysyansky P, Friedman Z, Tyomkin V, Fuchs T, Adam D, Krakover R, Vered Z: Circumferential and longitudinal strain in 3 myocardial layers in normal subjects and in patients with regional left ventricular dysfunction. J Am Soc Echocardiogr. 2010, 23 (1): 64-70. 10.1016/j.echo.2009.10.004. CrossRefPubMed
Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, Vogelsberg H, Fritz P, Dippon J, Bock CT, Klingel K, Kandolf R, Sechtem U: Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006, 114 (15): 1581-90. 10.1161/CIRCULATIONAHA.105.606509. CrossRefPubMed
Silva D, Marques P, Martins S, Bordalo E, Sá AL, Nóbrega J, Duarte J, Almeida AG, Gabriel HM, Correia MJ, Diogo AN: Coronary artery vasospasm and acute myocarditis: a rare association. Rev Port Cardiol. 2010, 29 (12): 1879-88. PubMed
Lewis JR, Kisileysky R, Armstrong PW: Prinzmetal’s angina, normal coronary arteries and pericarditis. CMA Journal. 1978, 119 (1): 36-9.
Yilmaz A, Mahrholdt H, Athanasiadis A, Vogelsberg H, Meinhardt G, Voehringer M, Kispert EM, Deluigi C, Baccouche H, Spodarev E, Klingel K, Kandolf R, Sechtem U: Coronary vasospasm as the underlying cause for chest pain in patients with PVB19 myocarditis. Heart. 2008, 94: 1456-1463. 10.1136/hrt.2007.131383. CrossRefPubMed
Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, Fritz P, Klingel K, Kandolf R, Sechtem U: Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004, 109: 1250-1258. 10.1161/01.CIR.0000118493.13323.81. CrossRefPubMed
Shirani J, Freant LJ, Roberts WC: Gross and semiquantitative histologic findings in mononuclear cell myocarditis causing sudden death, and implications for endomyocardial biopsy. Am J Cardiol. 1993, 15 (12): 952-957. CrossRef
- Left ventricular function in acute inflammatory peri-myocardial diseases – new insights and long-term follow-up
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II