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Myocarditis Microchapters |
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Myocarditis laboratory findings On the Web |
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Editor-In-Chief:C. Michael Gibson, M.S., M.D.[1]Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S., Maliha Shakil, M.D.[2] Homa Najafi, M.D.[3]
Overview
Laboratory findings consistent with the diagnosis of myocarditis include elevatedmarkers of myonecrosis, inflammatorymarkers, and other biomarkers. Markers of myonecrosis include creatine kinase (CK-MB), cardiac troponin I (cTnI) or T (cTnT), lactate dehydrogenase (LDH), alanine transaminase (ALT), and aspartate transaminase (AST). Elevated levels of C-reactive protein and erythrocyte sedimentation rate (ESR), and leukocytosis are suggestive of myocarditis. Serologicmarkers such as Fas, Fas ligand, interleukin-10 or antimyosin autoantibodies are of prognostic value in myocarditis. Other auto-antibodies such as ANA and rheumatoid factor may also be detected.
Laboratory Findings
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Markers of Myonecrosis
The following markers of myonecrosis are often elevated in myocarditis, particularly early on in the course of the disease:[1][2][3][4][5] Securityspy 5 2 1 – multi camera video surveillance app.
- Creatine kinase (CK-MB)
- Cardiac troponin I (cTnI) or T (cTnT) are elevated more frequently than CK-MB (34-53% versus 2-6 %) as reported in two series. Cardiac troponin I is elevated early in the course and is suggestive of acute myocarditis. Persistently elevatedcTnT or CK-MB is suggestive of ongoing myonecrosis. Cardiac enzymes may also be useful in differentiating myocarditis from dilated cardiomyopathy as CK-MB and cTnT levels are higher in myocarditis than dilated cardiomyopathy.
- Lactate dehydrogenase (LDH)
- Alanine transaminase (ALT)
- Aspartate transaminase (AST)
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Note:AST is considered to be the most sensitive marker of myocarditis with the sensitivity of 85%. However, the specificities of AST and ALT are low in patients with myocarditis as they may be elevatedsecondary to other coexisting systemic or organdysfunction.
Inflammatory Markers
The following inflammatory markers are often elevated:[6][7]
- CBC: leukocytosis or eosinophilia in hypersensitivemyocarditis.
- Erythrocyte sedimentation rate (ESR)
Other Biomarkers
- Serologicalmarkers such as Fas, Fas ligand, interleukin-10 or antimyosin autoantibodies are of prognostic value in myocarditis. [8][9][10][11]
- Fas and Fas ligand are markers of cell death (apoptosis) and are associated with cardiac dysfunction.
- Antimyosin autoantibodies are associated with left ventricular systolic dysfunction and diastolic stiffness in patients with chronic myocarditis.
- High levels of interleukin-10 in fulminant myocarditis patients at admission may be predictive of subsequent development of cardiogenic shock (requiring mechanical cardiopulmonarysupportsystem) and mortality.
- Viralantibody titers for coxsackie B virus, human immunodeficiency virus (HIV), cytomegalovirus, Ebstein-Barr virus, hepatitis virus family, and influenza virus may be useful in diagnosis the causative organism. However, the management of myocarditis due to a viraletiology seldom differs depending upon the virus, and therefore, antibody titers are rarely indicated in the diagnostic evaluation of myocarditis.
- Auto-antibodies such as ANA, rheumatoid factor, and anti-topoisomerase antibodies may identify conditions that respond to immunosuppressive therapy.
- Polymerase chain reaction (PCR) may be used in the detection of and identification of viral infections from myocardial biopsy, pericardial fluid or other bodyfluids. Persistence of a viralgenome is indicative of a poor prognosis.
References
- ↑Smith SC, Ladenson JH, Mason JW, Jaffe AS (1997). 'Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates'. Circulation. 95 (1): 163–8. PMID8994432.
- ↑Lauer B, Niederau C, Kühl U, Schannwell M, Pauschinger M, Strauer BE; et al. (1997). 'Cardiac troponin T in patients with clinically suspected myocarditis'. J Am Coll Cardiol. 30 (5): 1354–9. PMID9350939.
- ↑Soongswang J, Durongpisitkul K, Ratanarapee S, Leowattana W, Nana A, Laohaprasitiporn D; et al. (2002). 'Cardiac troponin T: its role in the diagnosis of clinically suspected acute myocarditis and chronic dilated cardiomyopathy in children'. Pediatr Cardiol. 23 (5): 531–5. PMID12211203.
- ↑Freedman SB, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J (2007). 'Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation'. Pediatrics. 120 (6): 1278–85. doi:10.1542/peds.2007-1073. PMID18055677.
- ↑Lippi G, Salvagno GL, Guidi GC (2008). 'Cardiac troponins in pediatric myocarditis'. Pediatrics. 121 (4): 864, author reply 864-5. doi:10.1542/peds.2008-0031. PMID18381554.
- ↑Giovanni Donato Aquaro, Matteo Perfetti, Giovanni Camastra, Lorenzo Monti, Santo Dellegrottaglie, Claudio Moro, Alessia Pepe, Giancarlo Todiere, Chiara Lanzillo, Alessandra Scatteia, Mauro Di Roma, Gianluca Pontone, Martina Perazzolo Marra, Andrea Barison & Gianluca Di Bella (2017). 'Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function: ITAMY Study'. Journal of the American College of Cardiology. 70 (16): 1977–1987. doi:10.1016/j.jacc.2017.08.044. PMID29025554.Unknown parameter
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ignored (help) - ↑Michela Brambatti, Maria Vittoria Matassini, Eric D. Adler, Karin Klingel, Paolo G. Camici & Enrico Ammirati (2017). 'Eosinophilic Myocarditis: Characteristics, Treatment, and Outcomes'. Journal of the American College of Cardiology. 70 (19): 2363–2375. doi:10.1016/j.jacc.2017.09.023. PMID29096807.Unknown parameter
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ignored (help) - ↑Sheppard R, Bedi M, Kubota T, Semigran MJ, Dec W, Holubkov R; et al. (2005). 'Myocardial expression of fas and recovery of left ventricular function in patients with recent-onset cardiomyopathy'. J Am Coll Cardiol. 46 (6): 1036–42. doi:10.1016/j.jacc.2005.05.067. PMID16168288.
- ↑Lauer B, Schannwell M, Kühl U, Strauer BE, Schultheiss HP (2000). 'Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis'. J Am Coll Cardiol. 35 (1): 11–8. PMID10636253.
- ↑Nishii M, Inomata T, Takehana H, Takeuchi I, Nakano H, Koitabashi T; et al. (2004). 'Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis'. J Am Coll Cardiol. 44 (6): 1292–7. doi:10.1016/j.jacc.2004.01.055. PMID15364334.
- ↑Kühl U, Pauschinger M, Seeberg B, Lassner D, Noutsias M, Poller W; et al. (2005). 'Viral persistence in the myocardium is associated with progressive cardiac dysfunction'. Circulation. 112 (13): 1965–70. doi:10.1161/CIRCULATIONAHA.105.548156. PMID16172268.
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