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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

View larger version (107K): [in a new window]   Figure 1 Digitalized antimyosin scan with color coding of regional pulse rates recorded 48 h after administration of 0.5 mg of R11D10-Fab-DPTA monoclonal antimyosin antibodies labeled with 75 MBq of indium-111 intravenously. The most intense staining is located over the liver (thick arrow), but staining of the ventricular wall is also clearly visible (thin arrows).

View larger version (10K): [in a new window]   Figure 2 Antimyosin scintigraphy and findings in the endomyocardial biopsy in 65 patients with clinically suspected myocarditis. The antimyosin scan (AMS) was considered positive (+) when antimyosin antibody uptake in the ventricular wall was clearly visible; the endomyocardial biopsy was considered positive when histologic and/or immunohistologic evidence of myocarditis was detected.

View larger version (11K): [in a new window]   Figure 3 Antimyosin scintigraphy and separate analysis of histologic and immunohistologic findings in the endomyocardial biopsy in 65 patients with clinically suspected myocarditis. AMS = antimyosin scintigraphy. + = positive antimyosin scan with clear antimyosin antibody uptake in the ventricular wall. – = negative antimyosin scan with no clear antimyosin antibody uptake in the ventricular wall. Histo = results of histologic analysis of the endomyocardial biopsy; acute MC = acute myocarditis; bord MC = borderline myocarditis; no MC = no myocarditis. ImHisto = results of immunohistologic analysis of the endomyocardial biopsy; lymph MC = lymphocytic myocarditis; no MC = no myocarditis.