Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms

OBJECTIVES The aim of this study was to assess the diagnosis of myocarditis in patients presenting with acute myocardial infarction (MI) and normal co ronary angiograms. BACKGROUND Most often in these patients, the etiologic diagnosis remains un clear once they are found to hare normal coronary arteries. The diagnosis o f myocarditis mimicking MI is clinically relevant, because numerous argumen ts suggest a relation between myocarditis and dilated cardiomyopathy. Myoca rdial indium-111 (In-111)-antimyosin antibody (AMA)/rest thallium-201 (Tl-2 01) imaging allows noninvasive detection of myocarditis. METHODS Forty-five patients admitted to three intensive care units for susp icion of acute MI, with normal coronary angiograms, were investigated. Indi um-111-AMA planar images and then a dual-isotope rest AMA/Tl-201 tomographi c study were performed. Six-month echocardiographic follow-up was obtained in 80% of the patients with initial left ventricular (LV) wall motion abnor malities. RESULTS In eight patients, AMA and Tl-201 scintigraphy were negative. In tw o patients, a matched Tl-201 defect and focal AMA uptake suggested acute MI (due to prolonged vasospasm or spontaneously reperfused coronary occlusion ). In 17 patients, diffuse AMA uptake over the whole LV suggested diffuse m yocarditis. In 18 patients, focal AMA uptake with a normal Tl-201 scan sugg ested diffuse but heterogeneous, or focal myocarditis. Complete functional recovery was observed in 81% of the patients with a pattern of myocarditis. CONCLUSIONS Among 45 patients presenting with acute MI and normal coronary angiograms, 38% had diffuse myocarditis and 40% had a scintigraphic pattern of heterogeneous or focal myocarditis. Short-term follow-up showed complet e LV functional recovery in 81% of these patients. ii Am Coil Cardiol 2001; 37:786-92) (C) 2001 by the American College of Cardiology.