Kardiovaskuläre MRT: akute Myokarditis und myokardiale Mitbeteiligung bei Systemerkrankungen

Die kardiovaskuläre Magnetresonanztomografie (CMR) zeichnet sich als Bildgebungsmodalität zur nicht invasiven Myokarddifferenzierung aus. Myokarditiden zählen zu den wichtigsten Indikationen. Der folgende Beitrag zeigt, welche Möglichkeiten und Techniken die CMR zur Detektion einer akuten Myokarditis bietet, wie diese angewandt und ausgewertet werden und welche Fallstricke es gibt.

Schlüsselwörter

Kardiovaskuläre MRT - CMR - Myokarditis - Sarkoidose - Sklerodermie - Vaskulitis - systemischer Lupus erythematodes - Kardiotoxizität

• Literatur

• 1 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599-3726
• 2 Pelliccia A, Sharma S, Gati S. et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42: 17-96
• 3 Zeppenfeld K, Tfelt-Hansen J, de Riva M. et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43: 3997-4126
• 4 Messroghli DR, Moon JC, Ferreira VM. et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson 2017; 19: 75
• 5 Ferreira VM, Schulz-Menger J, Holmvang G. et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 2018; 72: 3158-3176
• 6 Caforio ALP, Pankuweit S, Arbustini E. et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34: 2636-2648
• 7 Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000; 343: 1388-1398
• 8 Haaf P, Garg P, Messroghli DR. et al. Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson 2016; 18: 89
• 9 Schulz-Menger J, Bluemke DA, Bremerich J. et al. Standardized image interpretation and post-processing in cardiovascular magnetic resonance – 2020 update. J Cardiovasc Magn Reson 2020; 22: 19
• 10 Ferreira VM, Fernandes JL, Basso C, Friedrich MG. European Association of Cardiovascular Imaging. Myocarditis. In: Ferrari V, Lombardi M, Plein S, Petersen SB, Bucciarelli-Ducci C, Buechel EV, Basso C. The EACVI Textbook of Cardiovascular Magnetic Resonance. Oxford: Oxford University Press; 2018: 290-308
• 11 Tschöpe C, Ammirati E, Bozkurt B. et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 2021; 18: 169-193
• 12 Basso C. Myocarditis. N Engl J Med 2022; 387: 1488-1500
• 13 Luetkens JA, Faron A, Isaak A. et al. Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort. Radiol Cardiothorac Imaging 2019; 1: e190010
• 14 von Knobelsdorff-Brenkenhoff F, Schüler J, Dogangüzel S. et al. Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2017; 10: e005242
• 15 Aquaro GD, Ghebru Habtemicael Y, Camastra G. et al. Prognostic Value of Repeating Cardiac Magnetic Resonance in Patients With Acute Myocarditis. J Am Coll Cardiol 2019; 74: 2439-2448
• 16 Petersen SE, Friedrich MG, Leiner T. et al. Cardiovascular Magnetic Resonance for Patients With COVID-19. JACC Cardiovasc Imaging 2022; 15: 685-699
• 17 Petersen EL, Goßling A, Adam G. et al. Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection: The Hamburg City Health Study COVID programme. Eur Heart J 2022; 43: 1124-1137
• 18 Puntmann VO, Carerj ML, Wieters I. et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5: 1265-1273
• 19 Gröschel J, Bhoyroo Y, Blaszczyk E. et al. Different Impacts on the Heart After COVID-19 Infection and Vaccination: Insights From Cardiovascular Magnetic Resonance. Front Cardiovasc Med 2022; 9: 916922
• 20 Breitbart P, Koch A, Schmidt M. et al. Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis. Clin Res Cardiol 2021; 110: 1832-1840
• 21 Artico J, Shiwani H, Moon JC. et al. Myocardial Involvement After Hospitalization for COVID-19 Complicated by Troponin Elevation: A Prospective, Multicenter, Observational Study. Circulation 2023; 147: 364-374
• 22 Puntmann VO, Martin S, Shchendrygina A. et al. Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nat Med 2022; 28: 2117-2123
• 23 Iking-Konert C, Mayet W-J, Kuchen S, Jenewein J, Büchi S, Zeidler H, Michel B. Rheumatische Syndrome bei verschiedenen nichtrheumatischen Erkrankungen. In: Zeidler H, Michel BA. Differenzialdiagnose rheumatischer Erkrankungen. Berlin, Heidelberg: Springer; 2019: 363-507
• 24 Mavrogeni SI, Kitas GD, Dimitroulas T. et al. Cardiovascular magnetic resonance in rheumatology: Current status and recommendations for use. Int J Cardiol 2016; 217: 135-148
• 25 Patel A, Miszalski-Jamka T, Mavrogeni S, Schulz-Menger J. European Association of Cardiovascular Imaging. Cardiac Involvement in systemic Diseases and secondary Cardiomyopathies. In: Ferrari V, Lombardi M, Plein S, Petersen SB, Bucciarelli-Ducci C, Buechel EV, Basso C. The EACVI Textbook of Cardiovascular Magnetic Resonance. Oxford: Oxford University Press; 2018: 343-353
• 26 Herold G. Innere Medizin 2022. Berlin: De Gruyter; 2021
• 27 Skowasch D, Gaertner F, Marx N. et al. Diagnostik und Therapie der kardialen Sarkoidose. Kardiologe 2020; 14: 14-25
• 28 Herrera CJ, Pina P, Martinez J. et al. Cardiac Imaging in Systemic Diseases: What the Clinician should Know. Curr Cardiol Rev 2018; 14: 175-184
• 29 Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet 2014; 384: 1878-1888
• 30 O’Neill SG, Woldman S, Bailliard F. et al. Cardiac magnetic resonance imaging in patients with systemic lupus erythematosus. Ann Rheum Dis 2009; 68: 1478-1481
• 31 Mavrogeni SI, Dimitroulas T, Kitas GD. Cardiovascular magnetic resonance in the diagnosis and management of cardiac and vascular involvement in the systemic vasculitides. Curr Opin Rheumatol 2019; 31: 16-24
• 32 Glynn P, Hale S, Hussain T. et al. Cardiovascular Imaging for Systemic Sclerosis Monitoring and Management. Front Cardiovasc Med 2022; 9: 846213
• 33 Cucuruzac R, Muntean I, Benedek I. et al. Right Ventricle Remodeling and Function in Scleroderma Patients. BioMed Res Int 2018; 2018: 4528148
• 34 Markousis-Mavrogenis G, Bournia V-K, Panopoulos S. et al. Cardiovascular Magnetic Resonance Identifies High-Risk Systemic Sclerosis Patients with Normal Echocardiograms and Provides Incremental Prognostic Value. Diagnostics (Basel) 2019; 9: E220
• 35 Jordan JH, Schmitt M, Miller CA, Angelini A, Hundley WG. European Association of Cardiovascular Imaging. Cardiac Involvement in oncologic Patients. In: Ferrari V, Lombardi M, Plein S, Petersen SB, Bucciarelli-Ducci C, Buechel EV, Basso C. The EACVI Textbook of Cardiovascular Magnetic Resonance. Oxford: Oxford University Press; 2018: 329-342
• 36 Lyon AR, López-Fernández T, Couch LS. et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43: 4229-4361
• 37 Muehlberg F, Funk S, Zange L. et al. Native myocardial T1 time can predict development of subsequent anthracycline-induced cardiomyopathy. ESC Heart Fail 2018; 5: 620-629
• 38 Muehlberg F, Kornfeld M, Zange L. et al. Early myocardial oedema can predict subsequent cardiomyopathy in high-dose anthracycline therapy. ESC Heart Fail 2023; 10: 616-627
• 39 Gulati G, Heck SL, Ree AH. et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J 2016; 37: 1671-1680
• 40 Muehlberg F, Blaszczyk E, Will K. et al. Characterization of critically ill patients with septic shock and sepsis-associated cardiomyopathy using cardiovascular MRI. ESC Heart Fail 2022; 9: 2147-2156
• 41 Hufnagel S, Metzner S, Kerkering KM. et al. 3D model-based super-resolution motion-corrected cardiac T1 mapping. Phys Med Biol 2022;
• 42 Gröschel J, Ammann C, Zange L. et al. Fast acquisition of left and right ventricular function parameters applying cardiovascular magnetic resonance in clinical routine – validation of a 2-shot compressed sensing cine sequence. Scand Cardiovasc J 2022; 56: 266-275
• 43 Cocker MS, Abdel-Aty H, Strohm O. et al. Age and gender effects on the extent of myocardial involvement in acute myocarditis: a cardiovascular magnetic resonance study. Heart 2009; 95: 1925-1930
• 44 Hadler T, Wetzl J, Lange S. et al. Introduction of Lazy Luna an automatic software-driven multilevel comparison of ventricular function quantification in cardiovascular magnetic resonance imaging. Sci Rep 2022; 12: 6629
• 45 Kim RJ, Simonetti OP, Westwood M. et al. Guidelines for training in cardiovascular magnetic resonance (CMR). J Cardiovasc Magn Reson 2018; 20: 57
• 46 Leiner T, Bogaert J, Friedrich MG. et al. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22: 76