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Cardiovascular Disease |

A Clinical Audit of Coronary Angiography in Patients With Suspected Acute Myocarditis

Dinis Mesquita, MD; Carla Nobre, MD; Boban Thomas, MD
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CHBM, Barreiro, Portugal


Chest. 2014;145(3_MeetingAbstracts):82A. doi:10.1378/chest.1824445
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Abstract

SESSION TITLE: Cardiovascular Disease Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Acute myocarditis is a clinical condition commonly encountered in Portugal in the winter season. As markers of cardiac necrosis are commonly elevated with symptoms resembling acute coronary syndromes with equivocal ECG alterations, patients undergo coronary angiography routinely. The advent of cardiac MRI with the formulation of the Lake Louise criteria has allowed for a diagnosis of acute myocarditis. The aim of the study was to audit the decision to use of coronary angiography in patients diagnosed clinically with acute myocarditis. The decision was left to the treating physician.

METHODS: Eighteen patients were admitted to a district general hospital without on-site cardiac catheterization or cardiac MRI with a diagnosis of acute myocarditis. Six patients had coronary angiography and all patients underwent cardiac MRI. The TIMI score for ACS was also calculated for each patient.

RESULTS: The cohort included 16 men, with a mean age of 31 years, with retrosternal or pleuritic chest pain present in 17, and dyspnea in one patient. 14 reported having a systemic viral syndrome, pharyngitis or tonsillitis in the preceding three weeks. Mean CK, CK-MB and Troponin I levels were 557 IU/l, 54 ng/mL and 9.94 ng/mL and 11 had an abnormal ECG with concave ST elevation in 8. The TMII score for ACS was 1 in all patients, indicating a low-risk and doubtful benefit of invasive strategy in those with ACS. A definite diagnosis of acute myocarditis based on the presence of edema and subepicardial late enhancement was present in 16 patients while two patients with only edema were considered to have probable myocarditis according to Lake Louise criteria. All six patients who underwent angiography had normal studies. All patients were discharged with no in-hospital cardiovascular events. At a follow-up of two years no patient has been readmitted for cardiovascular reasons.

CONCLUSIONS: One third of patients with a clinical suspicion of acute myocarditis underwent coronary angiography despite the fact that a definitive diagnosis of acute myocarditis was possible by cardiac MRI in 88% of cases and a low TIMI ACS score.

CLINICAL IMPLICATIONS: The use of coronary angiography routinely in patients with acute myocarditis is an example of poor resource deployment with negative effects to the patient and health care systems.

DISCLOSURE: The following authors have nothing to disclose: Dinis Mesquita, Carla Nobre, Boban Thomas

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