Antimyosin antibody cardiac imaging: its role in the diagnosis of myocarditis

Medical Services, Massachusetts General Hospital, Boston 02114.

Right ventricular endomyocardial biopsy currently remains the procedure of choice for identifying patients with symptomatic heart failure due to myocarditis from the larger population with idiopathic dilated cardiomyopathy. Despite its specificity, the sensitivity of right ventricular biopsy remains uncertain because of the focal or multifocal nature of the disease. Because myocyte necrosis is an obligate component of myocarditis, the use of indium-111 antimyosin imaging was evaluated in 82 patients with suspected myocarditis. Seventy-four patients had dilated cardiomyopathy of less than 1 year's duration (mean left ventricular ejection fraction 0.30 +/- 0.02); eight patients had normal left ventricular function (mean ejection fraction 0.59 +/- 0.03). Symptoms at presentation included congestive heart failure (92%), chest pain mimicking myocardial infarction (6%) and life-threatening ventricular tachyarrhythmias (2%). All patients underwent planar and single photon emission computed tomographic (SPECT) cardiac imaging after injection of indium-111-labeled antimyosin antibody fragments and right ventricular biopsy within 48 h of imaging. Antimyosin images were interpreted as either abnormal or normal and correlated with biopsy results. On the basis of the right ventricular histologic examination, the sensitivity of antimyosin imaging was 83%, specificity 53% and predictive value of a normal scan 92%. Improvement in left ventricular function occurred within 6 months of treatment in 54% of patients with an abnormal antimyosin scan compared with 18% of those with a normal scan (p less than 0.01). Antimyosin cardiac imaging may be useful for the initial evaluation of patients with dilated and nondilated cardiomyopathy and clinically suspected myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				M. G. Friedrich, U. Sechtem, J. Schulz-Menger, G. Holmvang, P. Alakija, L. T. Cooper, J. A. White, H. Abdel-Aty, M. Gutberlet, S. Prasad, et al. Cardiovascular Magnetic Resonance in Myocarditis: A JACC White Paper J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1475 - 1487. [Abstract] [Full Text] [PDF]

				M. Nahrendorf, D. E. Sosnovik, B. A. French, F. K. Swirski, F. Bengel, M. M. Sadeghi, J. R. Lindner, J. C. Wu, D. L. Kraitchman, Z. A. Fayad, et al. Multimodality Cardiovascular Molecular Imaging, Part II Circ Cardiovasc Imaging, January 1, 2009; 2(1): 56 - 70. [Full Text] [PDF]

				R. Dennert, H. J. Crijns, and S. Heymans Acute viral myocarditis Eur. Heart J., September 1, 2008; 29(17): 2073 - 2082. [Abstract] [Full Text] [PDF]

				H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper Noninvasive Imaging in Myocarditis J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2085 - 2093. [Abstract] [Full Text] [PDF]

				J. W. Magnani and G. W. Dec Myocarditis: Current Trends in Diagnosis and Treatment Circulation, February 14, 2006; 113(6): 876 - 890. [Full Text] [PDF]

				C. Peker, L. Sarda-Mantel, P. Loiseau, F. Rouzet, L. Nazneen, G. Martet, J.-M. Vrigneaud, A. Meulemans, G. Saumon, J.-B. Michel, et al. Imaging Apoptosis with 99mTc-Annexin-V in Experimental Subacute Myocarditis J. Nucl. Med., June 1, 2004; 45(6): 1081 - 1086. [Abstract] [Full Text] [PDF]

				M. E. R. Martin, J. L. Moya-Mur, M. Casanova, A. Crespo-Diez, E. Asin-Cardiel, J. M. Castro-Beiras, L. Diez-Jimenez, M. Ballester, I. Carrio, and J. Narula Role of Noninvasive Antimyosin Imaging in Infants and Children with Clinically Suspected Myocarditis J. Nucl. Med., March 1, 2004; 45(3): 429 - 437. [Abstract] [Full Text]

				L. Sarda, P. Colin, F. Boccara, D. Daou, R. Lebtahi, M. Faraggi, C. Nguyen, A. Cohen, M. S. Slama, P. G. Steg, et al. Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms J. Am. Coll. Cardiol., March 1, 2001; 37(3): 786 - 792. [Abstract] [Full Text] [PDF]

				U. Kuhl, B. Lauer, M. Souvatzoglu, H. Vosberg, and H.-P. Schultheiss Antimyosin scintigraphy and immunohistologic analysis of endomyocardial biopsy in patients with clinically suspected myocarditis--evidence of myocardial cell damage and inflammation in the absence of histologic signs of myocarditis J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1371 - 1376. [Abstract] [Full Text] [PDF]

				S. C. Smith, J. H. Ladenson, J. W. Mason, and A. S. Jaffe Elevations of Cardiac Troponin I Associated With Myocarditis: Experimental and Clinical Correlates Circulation, January 7, 1997; 95(1): 163 - 168. [Abstract] [Full Text]

				A NONINVASIVE TEST FOR MYOCARDITIS Journal Watch (General), July 13, 1990; 1990(713): 5 - 5. [Full Text]