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CLINICAL STUDY: MYOCARDIAL INFARCTION

Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms

Laure Sarda, MD^*, Patrice Colin, MD, Franck Boccara, MD, Doumit Daou, MD, Rachida Lebtahi, MD^*, Marc Faraggi, MD, PhD^*, Charles Nguyen, MD^*, Ariel Cohen, MD, PhD, Michel S. Slama, MD, Philippe G. Steg, MD, PhD and Dominique Le Guludec, MD, PhD^*

^* Nuclear Medicine Department, Bichat Hospital, Paris, France
Cardiology Department, Antoine Béclère Hospital, Clamart, France
Cardiology Department, St-Antoine Hospital, Paris, France
Cardiology Department, Bichat Hospital, Paris, France

Manuscript received May 16, 2000; revised manuscript received October 24, 2000, accepted November 29, 2000.

Reprint requests and correspondence: Dr. Laure Sarda, Service de médecine nucléaire, hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
dominique.leguludec{at}bch.ap-hop-paris.fr

OBJECTIVES

The aim of this study was to assess the diagnosis of myocarditis in patients presenting with acute myocardial infarction (MI) and normal coronary angiograms.

BACKGROUND

Most often in these patients, the etiologic diagnosis remains unclear once they are found to have normal coronary arteries. The diagnosis of myocarditis mimicking MI is clinically relevant, because numerous arguments suggest a relation between myocarditis and dilated cardiomyopathy. Myocardial indium-111 (¹¹¹In)-antimyosin antibody (AMA)/rest thallium-201 (²⁰¹Tl) imaging allows noninvasive detection of myocarditis.

METHODS

Forty-five patients admitted to three intensive care units for suspicion of acute MI, with normal coronary angiograms, were investigated. Indium-111–AMA planar images and then a dual-isotope rest AMA/²⁰¹Tl tomographic study were performed. Six-month echocardiographic follow-up was obtained in 80% of the patients with initial left ventricular (LV) wall motion abnormalities.

RESULTS

In eight patients, AMA and ²⁰¹Tl scintigraphy were negative. In two patients, a matched ²⁰¹Tl defect and focal AMA uptake suggested acute MI (due to prolonged vasospasm or spontaneously reperfused coronary occlusion). In 17 patients, diffuse AMA uptake over the whole LV suggested diffuse myocarditis. In 18 patients, focal AMA uptake with a normal ²⁰¹Tl scan suggested diffuse but heterogeneous, or focal myocarditis. Complete functional recovery was observed in 81% of the patients with a pattern of myocarditis.

CONCLUSIONS

Among 45 patients presenting with acute MI and normal coronary angiograms, 38% had diffuse myocarditis and 40% had a scintigraphic pattern of heterogeneous or focal myocarditis. Short-term follow-up showed complete LV functional recovery in 81% of these patients.

Abbreviations and Acronyms   AMA = antimyosin antibody   CK = creatine kinase   HLR = heart to lung ratio   IDC = idiopathic dilated cardiopathy   111In = indium-111   LV = left ventricle or left ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   SPECT = single photon emission computed tomography   201Tl = thallium-201

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