Antimyosin antibody cardiac imaging : its role in the diagnosis of myocarditis

• Published in: Journal of the American College of Cardiology Vol. 16; no. 1; pp. 97 - 104
• Main Authors: DEC, G. W, PALACIOS, I, YASUDA, T, FALLON, J. T, KHAW, B. A, STRAUSS, H. W, HABER, E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.07.1990
• Subjects: Adolescent; Adult; Aged; ANIMALS; ANTIBODIES; Antibodies, Monoclonal; BETA DECAY RADIOISOTOPES; Biological and medical sciences; BODY; Cardiology. Vascular system; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; COMPUTERIZED TOMOGRAPHY; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSIS; DIAGNOSTIC TECHNIQUES; DISEASES; ELECTRON CAPTURE RADIOISOTOPES; EMISSION COMPUTED TOMOGRAPHY; Female; Follow-Up Studies; GLOBULINS; HEART; Humans; INDIUM 111; INDIUM ISOTOPES; Indium Radioisotopes; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; Male; MAMMALS; MAN; Medical sciences; Middle Aged; MINUTES LIVING RADIOISOTOPES; MONOCLONAL ANTIBODIES; MUSCLES; Myocarditis - diagnostic imaging; Myocarditis - pathology; Myocarditis - physiopathology; Myocarditis. Cardiomyopathies; MYOCARDIUM; Myocardium - pathology; MYOSIN; Myosins - immunology; NUCLEI; ODD-EVEN NUCLEI; ORGANIC COMPOUNDS; ORGANS; PRIMATES; PROTEINS; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOLOGY AND NUCLEAR MEDICINE; SCINTISCANNING; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Space life sciences; Stroke Volume; TOMOGRAPHY; Tomography, Emission-Computed, Single-Photon; VERTEBRATES 550601 > Medicine > Unsealed Radionuclides in Diagnostics; Radionuclide study; Human; Cardiovascular disease; Exploration; Monoclonal antibody; Scintigraphy; Photon; Myocarditis; Pathology; Biopsy; Immunological investigation; Myocardium; Positron emission tomography; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(90)90463-Y

Right ventricular endomyocardial biopsy currently remains the procedure of choice for identifying patients with symptomatic heart failure due to myocarditis from the larger population with idiopathic dilated cardiomyopathy. Despite its specificity, the sensitivity of right ventricular biopsy remains uncertain because of the focal or multifocal nature of the disease. Because myocyte necrosis is an obligate component of myocarditis, the use of indium-111 antimyosin imaging was evaluated in 82 patients with suspected myocarditis. Seventy-four patients had dilated cardiomyopathy of less than 1 year's duration (mean left ventricular ejection fraction 0.30 +/- 0.02); eight patients had normal left ventricular function (mean ejection fraction 0.59 +/- 0.03). Symptoms at presentation included congestive heart failure (92%), chest pain mimicking myocardial infarction (6%) and life-threatening ventricular tachyarrhythmias (2%). All patients underwent planar and single photon emission computed tomographic (SPECT) cardiac imaging after injection of indium-111-labeled antimyosin antibody fragments and right ventricular biopsy within 48 h of imaging. Antimyosin images were interpreted as either abnormal or normal and correlated with biopsy results. On the basis of the right ventricular histologic examination, the sensitivity of antimyosin imaging was 83%, specificity 53% and predictive value of a normal scan 92%. Improvement in left ventricular function occurred within 6 months of treatment in 54% of patients with an abnormal antimyosin scan compared with 18% of those with a normal scan (p less than 0.01). Antimyosin cardiac imaging may be useful for the initial evaluation of patients with dilated and nondilated cardiomyopathy and clinically suspected myocarditis.