Abstract
Introduction: In 1961 J. A. Hayes from Boston City Hospital reported in the British Heart Journal a case of myocarditis in a young man who died. Autopsy revealed inflammatory cells confined to the right heart. With the advent of cardiac MRI in the 1990s and its capability of detecting myocardial edema due to inflammation, it became apparent the some cases of arrhythmogenic right ventricular dysplasia (ARVD) were actually myocarditis. Since then, there has been no systematic study of right heart myocarditis. Hypothesis: Myocarditis confined to the right heart is detectable with cardiac MRI. Methods: An institutional cardiac imaging database was queried for all cases of CMR diagnosed myocarditis using published criteria, requiring 2 of the following 3 criteria: Myocardial enhancement on T2 weighted imaging (T2E), “early” myocardial gadolinium uptake (EGE) and standard late gadolinium enhancement (LGE). Patients with CMR evidence of myocarditis confined to the right heart constituted the study population. These patients were also required to have no evidence of left heart myocarditis, ie no T2E, EGE or DHE of LV myocardium. Results: 172 of 3,250 patients (5.3%) had evidence of myocarditis by CMR criteria. Of these 172 patients with myocarditis, 16(9.3%) were confined to the right heart. A typical case of right heart myocarditis is shown below, a T2 weighted 4 chamber CMR image showing myocardial enhancement(edema). All 16 patients complained of fatigue and palpitations. 4 of 16 had mild right heart failure on exam and RV hypokinesis on CMR or 2-D echo. 14 of 16 had documented atrial or ventricular tachy-arrhythmias. 14 of 16 had contiguous focal pericarditis (also confined to the right heart). Conclusions: Myocarditis confined to the right heart is evident in approximately 9% of patients with a CMR diagnosis of myocarditis. Palpitations and fatigue are the most common symptoms. Nearly all have a documentable arrhythmia and evidence of contiguous pericarditis on CMR.
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