Myoglobin for Detection of High-Risk Patients with Acute Myocarditis
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ORIGINAL ARTICLE
Myoglobin for Detection of High-Risk Patients with Acute Myocarditis Jan Kottwitz 1,2 & Katelyn A. Bruno 3 & Jan Berg 4 & Gary R. Salomon 3 & DeLisa Fairweather 3 & Mawahib Elhassan 4 & Nora Baltensperger 4 & Christine K. Kissel 4 & Marina Lovrinovic 4 & Andrea Baltensweiler 4 & Christian Schmied 4 & Christian Templin 4 & Joao A.C. Lima 5 & Ulf Landmesser 6 & Thomas F. Lüscher 7,8 & Robert Manka 4 & Bettina Heidecker 4,6 Received: 11 November 2019 / Accepted: 14 January 2020 # The Author(s) 2020
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.
Keywords Magnetic resonance imaging . Late gadolinium enhancement . Myocarditis . Myocardial inflammation . Cardiac enzymes . Myoglobin . Troponin . Biomarker Abbreviations aHTN Arterial hypertension CAD Coronary artery disease CMR Cardiac magnetic resonance imaging DCM Dilated cardiomyopathy DM Diabetes mellitus
EMB CK CRP CRT-P ICD Lc
Endomyocardial biopsy Creatine kinase C-reactive protein Cardiac resynchronization therapy pacemaker Implantable cardioverter defibrillator Leukocytes
Associate Editor Craig Stolen oversaw the review of this article Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12265-020-09957-8) contains supplementary material, which is available to authorized users. * Bettina Heidecker [email protected]
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Department of Cardiology, The Johns Hopkins University, Baltimore, MD, USA
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Emergency Department, University Hospital of Zurich, Zürich, Switzerland
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2
Department of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
Department of Cardiology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
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3
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
Center for Molecular Cardiology, University of Zurich, Zürich, Switzerland
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Department of Cardiology, University Hospital of Zurich, Zürich, Switzerland
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Royal Brompton and Harefield Hospitals and Imperial College, London, UK
J. of Cardiovasc. Trans. Res.
LGE LVEF NT-pro BNP PVC rs SD Tc TnT-hs VT
Late gadolinium enhancement Left ventricular e
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