Author + information
- Received January 29, 2018
- Revision received February 27, 2018
- Accepted March 7, 2018
- Published online June 25, 2018.
- Dimitri Patriki, MDa,
- Eva Gresser, BSca,
- Robert Manka, MDa,
- Maximilian Y. Emmert, MD, PhDb,
- Thomas F. Lüscher, MDa,c,d and
- Bettina Heidecker, MDa,∗ ()
- aDepartment of Cardiology, University Hospital Zurich, Zurich, Switzerland
- bClinic for Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
- cCenter for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- dRoyal Brompton and Harefield Hospital Imperial College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Bettina Heidecker, Department of Cardiology, University Hospital, Rämistrasse 100, CH-8091 Zürich, Switzerland.
Objectives This study sought to obtain an approximation of the true incidence of myocarditis by systematic screening of patients at risk using cardiac magnetic resonance imaging (CMR) in a tertiary care center.
Background Underdiagnosis of myocarditis and resulting uncertainty about its incidence remain a clinical dilemma. The authors hypothesized that systematic screening of patients presenting with angina-like symptoms, elevated troponin T, and no significant coronary artery disease using CMR will provide an approximation of the true incidence of myocarditis.
Methods The authors performed a retrospective chart review of patients presenting with angina-like symptoms and elevated high-sensitivity troponin T (TnT-hs ≥14 ng/l) in 2015 and 2016. During the year 2015, only patients with elevated TnT-hs, no significant coronary artery disease, and moderate-to-high clinical likelihood of myocarditis underwent CMR. Starting in 2016, CMR was obtained in patients with similar presentation, but independent of clinical likelihood of myocarditis.
Results A total of 1,788 patients (74% male, age 69 ± 14 years) qualified for our analysis. In 2015, 521 patients presented with angina-like symptoms and TnT-hs elevation. In 2016, the number increased to 1,267 patients. Although in the year 2015, a total of 4 of 88 (5%) CMRs were positive for myocarditis, the percentage of positive CMRs doubled (26 of 199; 13%; p = 0.03) in 2016.
Conclusions A novel diagnostic screening algorithm led to a 6.3-fold increase of the incidence of myocarditis in our hospital. Furthermore, the percentage of CMRs positive for myocarditis doubled, supporting the diagnostic value of this method. Considering the potentially lethal adverse events of myocarditis if left untreated, we recommend a low threshold for the use of CMR in patients with angina-like symptoms and elevated TnT-hs after exclusion of coronary artery disease.
This work was supported through funding from the Forschungskredit of the University of Zurich and the Holcim Foundation (Holcim Stiftung zur Förderung der wissenschaftlichen Fortbildung, Switzerland) issued to Dr. Bettina Heidecker. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 29, 2018.
- Revision received February 27, 2018.
- Accepted March 7, 2018.
- 2018 American College of Cardiology Foundation