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01-04-2015 | Original Communication

Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography

Authors: Angela Rosenbohm, Dominik Buckert, Nora Gerischer, Thomas Walcher, Jan Kassubek, Wolfgang Rottbauer, Albert C. Ludolph, Peter Bernhardt

Published in: Journal of Neurology | Issue 4/2015

Abstract

The aim of this study was to investigate cardiac involvement in patients with idiopathic inflammatory myopathies excluding inclusion body myositis with cardiac magnetic resonance tomography (CMR). A case series of 53 patients with polymyositis, dermatomyositis, or non-specific myositis underwent CMR including functional imaging, T1-weighted, and late gadolinium enhancement (LGE) imaging. T1-weighted and LGE images were analyzed for myocardial enhancement. Reduced left ventricular function (LVF) was found in 9 (7 %) patients. Patients with reduced LVF more often presented with early and late myocardial enhancement (p = 0.014 and p = 0.001). In 33 (62.3 %) patients, LGE was observed by CMR. These patients had significantly lower left ventricular ejection fractions (p < 0.001) compared to patients without LGE. LGE was mainly present in the lateral (p < 0.01) and inferior (p < 0.02) segments. No correlations of LGE presence or reduced LVF to cardiovascular risk factors were found. Myocardial inflammation is very frequent in polymyositis, dermatomyositis, and non-specific myositis. In our patient, cohort CMR demonstrated signs of myocardial inflammation in 62.3 %. CMR seems to offer a measurable and quantifiable diagnostic tool for cardiac involvement of idiopathic inflammatory myopathies and can thus be used to monitor disease progress and therapeutic success in these patients.

Dalakas MC (1991) Polymyositis, dermatomyositis, and inclusion-body myositis. N Engl J Med 325:1487–1498CrossRefPubMed

Oppenheim HZ (1899). Dermatomyositis. Berl klin Wochenschr:805–807

Hochberg MC, Feldman D, Stevens MB (1986) Adult onset polymyositis/dermatomyositis: an analysis of clinical and laboratory features and survival in 76 patients with a review of the literature. Semin Arthritis Rheum 15:168–178CrossRefPubMed

Denbow CE, Lie JT, Tancredi RG, Bunch TW (1979) Cardiac involvement in polymyositis: a clinicopathologic study of 20 autopsied patients. Arthritis Rheum 22:1088–1092CrossRefPubMed

Dankó K, Ponyi A, Constantin T, Borgulya G, Szegedi G (2004) Long-term survival of patients with idiopathic inflammatory myopathies according to clinical features: a longitudinal study of 162 cases. Med (Baltim) 83:35–42CrossRef

Benbassat J, Gefel D, Larholt K, Sukenik S, Morgenstern V, Zlotnick A (1985) Prognostic factors in polymyositis/dermatomyositis. A computer-assisted analysis of ninety-two cases. Arthritis Rheum 28:249–255CrossRefPubMed

Taylor AJ, Wortham DC, Burge JR, Rogan KM (1993) The heart in polymyositis: a prospective evaluation of 26 patients. Clin Cardiol 16:802–808CrossRefPubMed

Byrnes TJ, Baethge BA, Wolf RE (1991) Noninvasive cardiovascular studies in patients with inflammatory myopathy. Angiology 42:843–848CrossRefPubMed

Zhang L, Wang GC, Ma L, Zu N (2012) Cardiac involvement in adult polymyositis or dermatomyositis: a systematic review. Clin Cardiol 35:686–691CrossRefPubMed

10.

Bohan A, Peter JB, Bowman RL, Pearson CM (1977) Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Med (Baltim) 56:255–286CrossRef

11.

Behan WM, Behan PO, Gairns J (1987) Cardiac damage in Polymyositis associated with antibodies to tissue ribonucleoproteins. Br Heart J 57:167–180CrossRef

12.

Gottdiener JS, Sherber HS, Hawley RJ, Engel WK (1978) Cardiac manifestations in polymyositis. Am J Cardiol 41:1141–1149CrossRefPubMed

13.

Marholdt H, Goedecke C, Wagner A et al (2004) Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 109:1250–1258CrossRef

14.

Friedrich MG, Sechtem U, Schulz-Menger J et al (2009) International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol 53:1475–1478PubMedCentralCrossRefPubMed

15.

Walcher T, Steinbach P, Spieß J et al (2011) Detection of long-term progression of myocardial fibrosis in Duchenne muscular dystrophy in an affected family: a cardiovascular magnetic resonance study. Eur J Radiol 80:115–119CrossRefPubMed

16.

Yilmaz A, Gdynia HJ, Marholdt H, Sechtem U (2009) Cardiovascular magnetic resonance reveals similar damage to heart of patients with Becker and limb-girdle muscular dystrophy but no cardiac symptoms. J Magn Reson Imaging 30:876–877CrossRefPubMed

17.

Allanore Y, Vignaux O, Arnaud L et al (2006) Effects of corticosteroids and immunosuppressors on idiopathic inflammatory myopathy related myocarditis evaluated by magnetic resonance imaging. Ann Rheum Dis 65:249–252PubMedCentralCrossRefPubMed

18.

Ponfick M, Gdynia HJ, Kassubek J et al (2011) Cardiac involvement in juvenile overlap-myositis detected by cardiac magnetic resonance imaging. Int J Cardiol 152:e25–e26CrossRefPubMed

19.

Dubowitz V, Sewry CA (2013) Histological and histochemical stains and reactions. Muscle biopsy. A practical approach. Saunders Elsevier, Philadelphia, pp 16–27

20.

Buckert D, Dewes P, Walcher T, Rottbauer W, Bernhardt P (2013) Intermediate term prognostic value of reversible perfusion deficit diagnosed by adenosine perfusion cardiac magnetic resonance imaging—a prospective follow-up study in a consecutive patient population. J Am Coll Cardiol Img 6:56–63CrossRef

21.

Laissy JP, Messin B, Varenne O et al (2002) MRI of acute myocarditis: a comprehensive approach based on various imaging sequences. Chest 122:1638–1648CrossRefPubMed

22.

Bondarenko O, Beek AM, Hofman MB et al (2005) Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR. J Cardiovasc Magn Reson 7:481–485CrossRefPubMed

23.

Hoogendijk JE, Amato AA, Lecky BR et al (2004) 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10–12 October 2003, Naarden, The Netherlands. Neuromuscul Disord 14:337–345CrossRefPubMed

24.

Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology at the American Heart Association. Circulation 105:539–542CrossRefPubMed

25.

Puchalski MD, Williams RV, Askovich B et al (2009) Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy? Int J Cardiovasc Imaging 25:57–63PubMedCentralCrossRefPubMed

26.

Baur LHB (2009) Early detection of cardiomyopathy in Duchenne muscular dystrophy, is there a role for MRI? Int J Cardiovasc Imaging 25:69–70CrossRefPubMed

27.

Park CH, Choi EY, Greiser A, Paek MY, Hwang SH, Kim TH (2013) Diagnosis of acute global myocarditis using cardiac MRI with quantitative t1 and t2 mapping: case report and literature review. Korean J Radiol 14:727–732PubMedCentralCrossRefPubMed

Title: Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography
Authors: Angela Rosenbohm
Dominik Buckert
Nora Gerischer
Thomas Walcher
Jan Kassubek
Wolfgang Rottbauer
Albert C. Ludolph
Peter Bernhardt
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 4/2015
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-014-7623-1

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Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography

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