Myocarditis during acute inflammatory myopathies: Evaluation using clinical criteria and cardiac magnetic resonance imaging

Abstract

Polymyositis (PM)/dermatomyositis (DM) are inflammatory myopathies (IM) that may be complicated by myocarditis. To diagnose myocarditis in IM remains a challenge, due to a high risk for death and a lack of standardized diagnostic criteria [ [1] Lundberg I.E. The heart in dermatomyositis and polymyositis. Rheumatology. 2006; 45: iv18-iv21 Crossref PubMed Scopus (156) Google Scholar ]. Cardiac magnetic resonance (CMR) has been successfully used in myocarditis detection [ 2 Mavrogeni S. Spargias C. Bratis C. et al. Myocarditis as a precipitating factor for heart failure: evaluation and 1-year follow-up using cardiovascular magnetic resonance and endomyocardial biopsy. Eur J Heart Fail. 2011; 13: 830-837 Crossref PubMed Scopus (69) Google Scholar , 3 Friedrich M.G. Sechtem U. Schulz-Menger J. et al. International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009; 53: 1475-1487 Abstract Full Text Full Text PDF PubMed Scopus (1667) Google Scholar , 4 Mavrogeni S. Spargias K. Markussis V. et al. Myocardial inflammation in autoimmune diseases: investigation by cardiovascular magnetic resonance and endomyocardial biopsy. Inflamm Allergy Drug Targets. 2009; 8: 390-397 Crossref PubMed Scopus (67) Google Scholar ]. However, studies about IM are scarce [ 5 Mavrogeni S. Douskou M. Manoussakis M.N. Contrast-enhanced CMR imaging reveals myocardial involvement in idiopathic inflammatory myopathy without cardiac manifestations. JACC Cardiovasc Imaging. 2011; 4: 1324-1325 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar , 6 Allanore Y. Vignaux O. Arnaud L. et al. Effects of corticosteroids and immunosuppressors on idiopathic inflammatory myopathy related myocarditis evaluated by magnetic resonance imaging. Ann Rheum Dis. 2006; 65: 249-252 Crossref PubMed Scopus (100) Google Scholar ]. Currently, IM myocarditis documentation is based on ECG, laboratory and echocardiographic findings, but these criteria are of limited value [ [1] Lundberg I.E. The heart in dermatomyositis and polymyositis. Rheumatology. 2006; 45: iv18-iv21 Crossref PubMed Scopus (156) Google Scholar ]. Our aim was to evaluate the possibility of myocarditis in acute IM by clinical and CMR criteria.