This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kühl, U. Articles by Schultheiss, H.-P. Search for Related Content PubMed PubMed Citation Articles by Kühl, U. Articles by Schultheiss, H.-P.

CLINICAL STUDIES

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

Uwe Kühl, MD^*, Bernward Lauer, MD, Michael Souvatzoglu, MD, Henning Vosberg, MD and Heinz-Peter Schultheiss, MD^*

^* Universitätsklinikum Benjamin Franklin, Abteilung Kardiologie, Berlin, Germany
Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Herzzentrum, Germany
Nuklearmedizinische Klinik, Universität Düsseldorf, Düsseldorf, Germany

Manuscript received October 31, 1997; revised manuscript received June 25, 1998, accepted July 15, 1998.

Address for correspondence: Prof. Dr. med. Heinz-Peter Schultheiss, Medizinische Klinik und Poliklinik für Kardiologie und Pneumologie, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany

Objectives. This study compares the results of antimyosin scintigraphy in patients with clinically suspected myocarditis with histologic and immunohistologic findings in the endomyocardial biopsy.

Background. In patients with clinically suspected myocarditis, antimyosin scintigraphy often demonstrates myocardial cell damage but histologic evaluation of the endomyocardial biopsy often fails to show evidence of myocarditis. Recently developed immunohistologic techniques appear to be more sensitive for the detection of myocardial inflammation than histologic analysis alone. Studies comparing antimyosin scintigraphy and immunohistologic analysis of the endomyocardial biopsy in patients with clinically suspected myocarditis are not yet available.

Methods. Sixty-five patients with clinically suspected myocarditis underwent antimyosin scintigraphy. Antimyosin antibody uptake was correlated with histologic and immunohistologic findings in the endomyocardial biopsy.

Results. Antimyosin scintigraphy showed evidence of myocardial cell damage in 36 (55%) of the 65 patients and was negative in 29 (45%) patients. Histologic analysis of the endomyocardial biopsy revealed myocarditis in nine patients: six had a positive and three had a negative antimyosin scan, respectively. Thirty (83%) of 36 patients with evidence of myocardial cell damage on antimyosin scintigraphy were histologically negative for myocarditis. Immunohistologic analysis showed evidence of myocarditis in 31 (86%) of 36 patients with a positive antimyosin scan and also in 17 (59%) of 29 patients with a normal scan (p < 0.047).

Conclusions. Antimyosin scintigraphy often shows myocyte injury in patients with clinically suspected myocarditis. Histologic analysis of the endomyocardial biopsy alone is often negative, but additional immunohistologic analysis of the endomyocardial biopsy frequently provides evidence of myocardial inflammation in these patients. With immunohistologic analysis as the reference method, antimyosin scintigraphy has a high specificity but a lower sensitivity for the detection of myocarditis.

Abbreviations and Acronyms   AMS+ = patients with a positive antimyosin scan   AMS– = patients with a normal antimyosin scan   MHC = major histocompatibility complex   NS = not significant

This article has been cited by other articles:

				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]

				Y Allanore, O Vignaux, L Arnaud, X Puechal, S Pavy, D Duboc, P Legmann, and A Kahan Effects of corticosteroids and immunosuppressors on idiopathic inflammatory myopathy related myocarditis evaluated by magnetic resonance imaging Ann Rheum Dis, February 1, 2006; 65(2): 249 - 252. [Abstract] [Full Text] [PDF]

				H. Abdel-Aty, P. Boye, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M. G. Friedrich, and J. Schulz-Menger Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1815 - 1822. [Abstract] [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]

				D. C. Cassimatis, J. E. Atwood, R. M. Engler, P. E. Linz, J. D. Grabenstein, and M. N. Vernalis Smallpox vaccination and myopericarditis: a clinical review J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1503 - 1510. [Abstract] [Full Text] [PDF]

				J.-P. Laissy, B. Messin, O. Varenne, B. Iung, D. Karila-Cohen, E. Schouman-Claeys, and P. G. Steg MRI of Acute Myocarditis: A Comprehensive Approach Based on Various Imaging Sequences Chest, November 1, 2002; 122(5): 1638 - 1648. [Abstract] [Full Text] [PDF]

				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]

				A. M. Feldman and D. McNamara Myocarditis N. Engl. J. Med., November 9, 2000; 343(19): 1388 - 1398. [Full Text] [PDF]