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Role of Noninvasive Antimyosin Imaging in Infants and Children with Clinically Suspected Myocarditis

¹ Department of Nuclear Medicine, Hospital Ramón y Cajal, Madrid, Spain
² Cardiac Unit, Hospital Ramón y Cajal, Madrid, Spain
³ Pediatric Cardiac Unit, Hospital Ramón y Cajal, Madrid, Spain
⁴ Hospital Sant Pau, Barcelona, Spain
⁵ Hahnemann University Hospital, Philadelphia, Pennsylvania

Endomyocardial biopsy is an invasive procedure, often performed on children for the diagnosis of myocarditis, and is not without risk. Therefore, a noninvasive test of adequate diagnostic accuracy is highly desirable. We evaluated the role of antimyosin scintigraphy in infants and children with clinically suspected myocarditis. Methods: Forty patients (age range, 2 mo to 14 y) with suspected myocarditis underwent ¹¹¹In-antimyosin scintigraphy. All patients were clinically followed for 29 ± 17 mo; 21 patients underwent serial antimyosin scans (3.8 ± 1.7 per patient). The antimyosin uptake was assessed by heart-to-lung ratio (HLR). The scan results were compared with endomyocardial biopsy results in 22 patients. Results: Thirty-five of the 40 patients showed abnormal antimyosin findings; 17 patients showed intense myocardial antimyosin uptake (HLR > 2). The HLR was higher in patients presenting within the first 2 mo of illness (2.09 ± 0.43 vs. 1.74 ± 0.34, P = 0.01). Of 22 patients with endomyocardial biopsy, 17 demonstrated myocarditis. All 9 patients who had an HLR > 2 and underwent endomyocardial biopsy had histologic evidence of myocarditis. Of the remaining 13 patients with HLR < 2, 8 had biopsy-verified myocarditis (62%). The intensity of antimyosin uptake was the major determinant of survival in children, with a relative risk of 18 (confidence interval, 1.34–242; P = 0.027). High antimyosin uptake (HLR > 2) seen within 2 mo of the onset of symptoms was associated with a higher mortality rate. The survivors with an HLR > 2 and those with an HLR < 2 showed a high likelihood of complete functional recovery. Furthermore, the patients with serial antimyosin scans having persistently positive findings showed a poor clinical outcome. Conclusion: Intense myocardial uptake of antimyosin antibody is a reliable indicator of myocarditis in infants and children. Severe myocardial damage detected in the early phase of disease is associated with a higher mortality rate. The persistence of antimyosin uptake is associated with poor clinical outcomes.

Key Words: myocarditis • myosin • antibody radionuclide imaging • cardiomyopathy

This article has been cited by other articles:

				H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper Noninvasive Imaging in Myocarditis J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2085 - 2093. [Abstract] [Full Text] [PDF]