Author + information
- Pedro Gabriel Melo De Barros E. Silva,
- Luciana Baptista,
- Carlos Prazeres,
- Thiago Macedo,
- Marcio Sampaio,
- Jose Garcia and
- Valter Furlan
Background: The use of cardiac computed tomography angiography (CCTA) for the fast diagnosis of acute myocarditis in the emergency room is not established in clinical practice.
Methods: During 30 months, the patients who were treated in the emergency room with low pretest probability of coronary artery disease (CAD) and suspected myocarditis, were referred to cardiac angiography (MDCT Brilliance 64 Phillips) to exclude significant CAD associated with the late acquisition protocol for evaluation of late enhancement (LECT). Two independent observers assessed the exams as coronary anatomy, presence or absence of LECT and its pattern of myocardial damage. Continuous variables were analyzed using the Student t test and categorical variables using the Chi square test.
Results: A total of 44 patients were enrolled in the study. Of these, 30 had a history of infection until three weeks before of the first visit and 20 patients showed nonspecific changes on ECG. LECT was present in 36 patients. The most common LECT pattern was meso/epicardial, predominantly in the side walls and the inferior-lateral left ventricular (segments 5,11,16). The average level of troponin was 2,57±1.97mcg/dl and CK-MB 34.6±28.8ng/dl. Quantitative evaluation showed statistically significant difference between the attenuation of the main affected segments and segments without enhancement (p <0.001). There was a mild association between troponin levels and attenuation of myocardial segments (r = 0,1). The interobserver agreement was 100% for the presence or absence of LECT and strong correlation as its extension.
Conclusions: The use of coronary computed tomography angiography for exclusion of stenosis coronary stenosis in the emergency room is well established. When combined with the delayed enhancement protocol allows the fast diagnosis of acute myocarditis in a single exam, avoiding the coronary invasive investigation and the restricted use of Magnetic Resonance in the emergency.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:15 p.m.-1:25 p.m.
Session Title: Which Test Is Best for Pain in the Chest?
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1317M-09
- 2017 American College of Cardiology Foundation