2024/11 - Comparison of diagnostic algorithms in clinically suspected viral myocarditis: agreement between cardiac magnetic resonance, endomyocardial biopsy and troponin T [Journal Club]-November JCMR Journal Club Webinar

Video Transcription

Video Summary

The JCMR Journal Club featured a presentation on a prospective German study comparing cardiovascular MRI (CMR), endomyocardial biopsy (EMB), and high-sensitivity troponin in clinically suspected viral myocarditis. The study included 114 patients and found poor agreement between CMR and EMB, but much better agreement between CMR and troponin. CMR using native T1 and T2 mapping detected myocardial inflammation more consistently than biopsy, while EMB appeared more closely related to inflammatory cell counts and CRP than to myocardial injury.  <br /><br />The presenters argued that EMB should no longer be treated as a true gold standard for myocarditis, since it samples inflammation differently, may miss diffuse disease, and is biased toward sicker patients. They also emphasized that myocarditis should be viewed as a continuum rather than a binary condition, with mild or diffuse inflammatory involvement often missed by conventional echo or LGE imaging.  <br /><br />The discussion highlighted that CMR and EMB may be measuring different biological processes: CMR reflects edema and injury, while EMB reflects cellular infiltration. The speakers concluded that inflammatory myocardial involvement needs better definitions, better standardization, and outcome-driven trials before firm clinical decisions can be based on either test alone.

Keywords

myocarditis

cardiovascular MRI

endomyocardial biopsy

high-sensitivity troponin

native T1 mapping

T2 mapping

myocardial inflammation

German prospective study

JCMR Journal Club