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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Differentiation of Acute Myocarditis and Acute Myocardial Infarction by the Regional Distribution of Myocardial Irreversible Injury Using Cardiovascular Magnetic Resonance Imaging

1
Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santariškių Klinikos
2
Department of Radiology, Nuclear Medicine and Physics of Medicine, Faculty of Medicine Vilnius University
3
Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Klinikos
4
Clinic of Cardiovascular Medicine, Faculty of Medicine, Vilnius University
5
Faculty of Medicine, Vilnius University, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2012, 48(3), 18; https://doi.org/10.3390/medicina48030018
Received: 14 April 2011 / Accepted: 30 March 2012 / Published: 4 April 2012
Background and Objective. In this study, we have sought for differences between cardiovascular magnetic resonance patterns of acute myocarditis and acute myocardial infarction.
Material and Methods
. A prospective analysis of 110 consecutive patients was performed. The presence, precise location, and pattern of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance were investigated.
Results
. The subendocardial LGE pattern was much more frequent in the myocardial infarction group (76.7%) than myocarditis group (10.0%) (P<0.001). Meanwhile, midmyocardial LGE was much more typical of myocarditis (65.0%) than acute myocardial infarction (1.1%) (P<0.001), and epicardial LGE was also much more typical of myocarditis (55.0%) than acute myocardial infarction (0.0%) (P<0.001). Midmyocardial and epicardial LGE patterns were defined as a nonischemic LGE pattern more typical of myocarditis. Logistic regression analysis revealed that the subendocardial and midmyocardial LGE locations played the greatest role in differentiation between acute myocarditis and acute myocardial infarction. A statistical model based on midmyocardial LGE distribution and age showed a sensitivity of 90% and a specificity of 93.3% in differentiating between acute myocarditis and acute myocardial infarction.
Conclusion
. Our findings suggest that in clinical practice, differentiation between acute myocardial infarction and acute myocarditis can be done based on the subendocardial and midmyocardial LGE location. The presence of subendocardial LGE was found to be strongly associated with acute myocardial infarction; meanwhile, the presence of midmyocardial LGE indicated acute myocarditis. However, other clinical factors should also be taken into account when making the final diagnosis.
Keywords: myocarditis; myocardial infarction; late gadolinium enhancement myocarditis; myocardial infarction; late gadolinium enhancement
MDPI and ACS Style

Valevičienė, N.; Petrulionienė, Ž.; Petrauskienė, B.; Lauraitis, G.; Glaveckaitė, S.; Palionis, D.; Tamošiūnas, A.; Laucevičius, A. Differentiation of Acute Myocarditis and Acute Myocardial Infarction by the Regional Distribution of Myocardial Irreversible Injury Using Cardiovascular Magnetic Resonance Imaging. Medicina 2012, 48, 18.

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