磁共振成像时代急性心肌炎患者特点及中期随访。

Carma Karam, A. Alghamdi, N. Mansencal, S. Binsse, P. Lacombe, O. Dubourg
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引用次数: 0

摘要

背景:心肌炎是一种表现为多种症状的心肌组织炎症。心血管磁共振(CMR)已成为无创评估疑似患者心肌炎症的首选方法。目的:本研究的目的是报告单个中心CMR确诊的急性心肌炎患者的临床、临床旁和随访数据。方法:回顾性分析2010年11月至2012年11月收治的27例急性心肌炎患者。所有患者均行心电图、超声心动图和CMR检查。检测超敏心肌肌钙蛋白和CRP。在急性心肌梗死样综合征或存在心血管危险因素的情况下进行冠状动脉造影。我们回顾了医院门诊的档案,并通过电话联系了那些在医院外被跟踪的病人或他们的心脏病专家。结果:男性23例(85.2%),女性4例,年龄36±19岁。ST段抬高17例(62.9%)。所有患者的心肌肌钙蛋白均升高。超声心动图显示壁运动异常16例(59.2%)。CMR平均LVEF为53.96±9.9%,晚期钆增强在外侧占80%,下壁占10%,前壁或根尖壁占10%。冠状动脉造影正常,14例(51.8%)。并发症包括4例VT(14.8%), 2例房颤,1例心包填塞。随访23例(85%)。其中一人死于肺癌引发的肺栓塞。所有其他的都有一个有利的进化。结论:我们的研究表明心肌炎以年轻和男性患者为主。CMR是主要的诊断方式。在有心血管危险因素和/或心肌梗死样表现的情况下,冠状动脉造影是强制性的。进化往往是有利的。最佳的药物治疗仍有待确定。在没有胸痛的情况下,随访时超声心动图和/或CMR恢复正常,可以认为患者已经治愈。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
ACUTE MYOCARDITIS IN THE MAGNETIC RESONANCE IMAGING ERA: PATIENT’S CHARACTERISTICS AND MID-TERM FOLLOW-UP.
Background: Myocarditis is an inflammation of myocardial tissue that presents with a wide range of symptoms. Cardiovascular magnetic resonance (CMR) has become the first choice of non-invasive assessment of myocardial inflammation in suspected pts. Aims: The aim of this study was to report clinical, paraclinical and follow up data observed in pts with acute myocarditis confirmed by CMR in a single center.  Methods: We retrospectively studied27 pts admitted for acute myocarditis between November 2010 and November 2012. All pts had ECG, echocardiography and CMR. Ultrasensitive cardiac troponin and CRP were measured. Coronary angiogram was performed in case of acute myocardial infarction-like syndrome or in the presence of CV risk factors. We reviewed the files of the hospital out-patient clinic and contacted the pts or their cardiologists by phone for those followed outside the hospital. Results: There were 23 males (85.2%) and 4 females, aged 36 ± 19 yrs. ST elevation was found in17 pts (62.9%). All had elevated cardiac troponin. Echocardiography showed abnormalities of wall motion in16 pts (59.2%). Mean LVEF on CMR was 53.96 ± 9.9% and late gadolinium enhancement was in lateral in 80%, in inferior in 10% and anterior or apical wall in 10%. Coronary angiogram was normal, performed in14 pts (51.8%). Complications included VT in4 pts (14.8 %), AF in 2, and cardiac tamponade in 1. Follow-up was obtained for23 pts (85%).One died for pulmonary embolism on lung cancer. All others had a favorable evolution. Conclusion: Our study showed that myocarditis affects in majority young and male patients. CMR appears as the main modality of diagnosis. Coronary angiogram is mandatory in case of CV risk factors and/or myocardial infarction-like presentation. Evolution is often favorable. Optimal medical therapy is still to be defined. Pts can be considered as cured in the absence of chest pain and in case of normalization of echocardiography and/or CMR at follow-up.
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