Myoglobin for Detection of High-Risk Patients with Acute Myocarditis

Jan Kottwitz,Joao A.C Lima,Bettina Heidecker,Robert Manka,Jan Berg,Katelyn A Bruno,Nora Baltensperger,Marina Lovrinovic,Delisa Fairweather,Gary R Salomon,Ulf Landmesser,Thomas F Lüscher,Mawahib Elhassan,Christian Templin,Andrea Baltensweiler,Christian Schmied,Christine K Kissel

doi:10.1007/s12265-020-09957-8

Abstract

There is an unmet need for accurate and practical screening to detect myocarditis. We sought to test the hypothesis that the extent of acute myocarditis, measured by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), can be estimated based on routine blood markers. A total of 44 patients were diagnosed with acute myocarditis and included in this study. There was strong correlation between myoglobin and LGE (rs = 0.73 [95% CI 0.51; 0.87], p < 0.001), while correlation was weak between LGE and TnT-hs (rs = 0.37 [95% CI 0.09; 0.61], p = 0.01). Receiver operating curve (ROC) analysis determined myoglobin ≥ 87 μg/L as cutoff to identify myocarditis (92% sensitivity, 80% specificity). The data were reproduced in an established model of coxsackievirus B3 myocarditis in mice (n = 26). These data suggest that myoglobin is an accurate marker of acute myocarditis.Graphical Receiver operating curve analysis determined myoglobin ≥ 87 μg/L as cutoff to identify myocarditis and these data were reproduced in an established model of coxsackievirus B3 myocarditis in mice: CMRI, cardiac magnetic resonance imaging; Mb, myoglobin; LGE, late gadolinium enhancement; ROC, receiver operating curve analysis.

Highlights

Myocarditis is a common inflammatory cardiomyopathy presenting with various clinical manifestations and degrees of severity [1,2,3]
Forty-four patients diagnosed with acute myocarditis during the years 2011–2017 met inclusion criteria for the study
One patient underwent implantation of a cardioverter defibrillator (ICD) for ventricular fibrillation. Another patient received an implantable. This is the first study to demonstrate a strong correlation of myoglobin with late gadolinium enhancement (LGE) on Cardiac magnetic resonance imaging (CMR) in patients with acute myocarditis and to suggest a robust cutoff value for myoglobin to a

Summary

Introduction

Myocarditis is a common inflammatory cardiomyopathy presenting with various clinical manifestations and degrees of severity [1,2,3]. Circulating cardiac and inflammatory markers are routinely obtained from patients with acute myocarditis with TnT-hs being the gold standard [1, 2, 19]. It is uncertain if these markers reflect disease severity [1, 3, 6, 20,21,22]. We sought to test the hypothesis that the extent of acute myocarditis, measured by LGE on CMR, can be estimated based on routine cardiac and inflammatory markers

Methods

Results

Conclusion