Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal - Cardiovascular Imaging, jeac265. https://doi.org/10.1093/ehjci/jeac265 Dr. Pauli Pöyhönen et al
Points
- Giant cell myocarditis is an inflammatory heart disease with a perplexing pathophysiology and a difficult-to-diagnose overlap with cardiac sarcoidosis.
- Elevated atrial and ventricles blockage, sudden cardiac death, and prolonged ventricle tachyarrhythmia are symptoms shared by cardiac sarcoidosis and giant cell myocarditis, with cardiac arrest predominating in giant cell myocarditis and symptomatic atrioventricular block in cardiovascular sarcoidosis.
- There has been discussion that giant cell myocarditis and cardiac sarcoidosis represent various phenotypes of intensity within a spectrum of one primary disease.
- By electromagnetic resonance imaging, giant cell myocarditis and cardiac sarcoidosis look identical; however, granulomatous myocarditis differs from cardiac sarcoidosis in that myocardial inflammation has a more invasive physiologically and concerning prognostication.
Summary
Similar to cardiac sarcoidosis, giant cell myocarditis is an inflamed cardiogenic shock. This trial evaluates the magnetic resonance imaging results of giant cell myocarditis and compares them to cardiac sarcoidosis.
This randomized trial evaluated the cardiac magnetic resonance imaging results of 18 participants with giant cell myocarditis and 18 healthy adults with cardiac granuloma. This was a blinded trial; researchers only considered the results based on the age, gender, left ventricular ejection fraction, and cardiovascular symptoms presented by the trial participants.
In contrast to those with cardiac sarcoidosis, participants with giant cell myocarditis had symptoms for a shorter time and had increased levels of cardiovascular biomarkers. In addition, the average late gadolinium enhancement mass was lower in participants with giant cell myocarditis, even though all participants with giant cell myocarditis showed late gadolinium enhancement in a qualitatively identical pattern to that of participants with cardiac sarcoidosis.
The outcomes indicated that the ability to distinguish between giant cell myocarditis and cardiac sarcoidosis might depend more on medical traits than cardiac magnetic resonance imaging results.
Cardiac late gadolinium enhancement on magnetic resonance appeared common in myocardial inflammation and exhibited a pattern identical to cardiac sarcoidosis. For a similar level of left ventricular dysfunction, the late gadolinium enhancement appeared lower in giant cell myocarditis. Cardiac magnetic resonance findings that were thought to indicate cardiac sarcoidosis or even specific to it were equally common in giant cell myocarditis. Giant cell myocarditis had a worse transplant-free survival rate and was medically more malignant despite looking similar to cardiac sarcoidosis on cardiac magnetic resonance imaging.
Although myocardial inflammation appeared physiologically more severe and harmful in giant cell myocarditis, resonance imaging results were identical to cardiac sarcoidosis. In addition, when the presenting characteristics and left ventricular dysfunction were compared, left ventricular size and late gadolinium enhancement were lower in myocardial inflammation.
Link to the article: https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jeac265/6979937
References Pöyhönen, P., Nordenswan, H.-K., Lehtonen, J., Syväranta, S., Shenoy, C., & Kupari, M. (2023). Cardiac magnetic resonance in giant cell myocarditis: A matched comparison with cardiac sarcoidosis. European Heart Journal - Cardiovascular Imaging, jeac265. https://doi.org/10.1093/ehjci/jeac265
