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First-pass myocardial perfusion abnormalities in Churg-Strauss Syndrome with cardiac involvement

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Abstract

This study sought to evaluate whether representative abnormalities can be identified by first-pass perfusion (FPP) studies in patients with Churg-Strauss Syndrome (CSS), a rare disease characterized by small-vessel vasculitis. Seven patients with CSS (3 men, 4 women; mean age 55 ± 7 years) were investigated. Echocardiography was performed in all patients and coronary angiography in 5 patients. Magnetic resonance imaging (MRI) was performed with a 1.5 T whole body scanner in all patients. Functional cardiac imaging, T2-weighted turbo inversion recovery magnitude images, and T2-weighted turbo spin echo sequences with fat saturation were also performed. Cardiac viability was assessed by myocardial FPP imaging at rest and by delayed contrast enhancement (DCE) images. The FPP was abnormal in 5 of the 7 CSS patients. The abnormality was localized in the subendocardium of the left ventricle, particularly in areas of myocardial inflammatory edema. All patients showed subendocardial DCE abnormalities in the left ventricle, and 2 patients also in the right ventricle. The localization was typically subendocardial. This study describes a myocardial FPP deficit at rest in patients with CSS. The deficit is localized in areas of inflammatory myocardial edema. This diagnostic technique and image evaluation is simple, quick, and harmless. Due to the rarity of CSS, further studies are necessary to evaluate the impact of these findings.

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References

  1. Laddis T, Manning WJ, Danias PG (2001) Cardiac MRI for assessment of myocardial perfusion: current status and future perspectives. J Nucl Cardiol 8:207–214. doi:10.1067/mnc.2001.112539

    Article  PubMed  CAS  Google Scholar 

  2. Manning WJ, Atkinson DJ, Grossman W, Paulin S, Edelman RR (1991) First-pass nuclear magnetic resonance imaging studies using gadolinium-DTPA in patients with coronary artery disease. J Am Coll Cardiol 18:959–965

    Article  PubMed  CAS  Google Scholar 

  3. Barmeyer AA, Stork A, Muellerleile K, Schofer AK, Tiburtius C, Koester R et al (2008) Comparison of quantitative coronary angiography and first-pass perfusion magnetic resonance imaging for the detection of an impaired coronary perfusion in nonsevere coronary stenosis. J Magn Reson Imaging 27:1005–1011. doi:10.1002/jmri.21341

    Article  PubMed  Google Scholar 

  4. Canyigit M, Turkbey B, Hazirolan T, Peynircioglu B, Aytemir K (2008) Magnetic resonance imaging first-pass myocardial perfusion in evaluation of hemodynamic effects of myocardial bridging. J Comput Assist Tomogr 32:274–275. doi:10.1097/RCT.0b013e318074c5b7

    Article  PubMed  Google Scholar 

  5. Su MY, Yang KC, Wu CC, Wu YW, Yu HY, Tseng RY et al (2007) First-pass myocardial perfusion cardiovascular magnetic resonance at 3 Tesla. J Cardiovasc Magn Reson 9:633–644. doi:10.1080/10976640601093661

    Article  PubMed  Google Scholar 

  6. Arai AE (2000) Magnetic resonance first-pass myocardial perfusion imaging. Top Magn Reson Imaging 11:383–398. doi:10.1097/00002142-200012000-00007

    Article  PubMed  CAS  Google Scholar 

  7. Marcu CB, Beek AM, van Rossum AC (2006) Clinical applications of cardiovascular magnetic resonance imaging. CMAJ 175:911–917. doi:10.1503/cmaj.060566

    PubMed  Google Scholar 

  8. Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L et al (2008) Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art. J Cardiovasc Magn Reson 10:18. doi:10.1186/1532-429X-10-18

    Article  PubMed  Google Scholar 

  9. Chusid MJ, Dale DC, West BC, Wolff SM (1975) The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine (Baltimore) 54:1–27. doi:10.1097/00005792-197501000-00001

    Article  CAS  Google Scholar 

  10. Seo P, Stone JH (2004) The antineutrophil cytoplasmic antibody-associated vasculitides. Am J Med 117:39–50. doi:10.1016/j.amjmed.2004.02.030

    Article  PubMed  CAS  Google Scholar 

  11. Hasley PB, Follansbee WP, Coulehan JL (1990) Cardiac manifestations of Churg-Strauss syndrome: report of a case and review of the literature. Am Heart J 120:996–999. doi:10.1016/0002-8703(90)90227-O

    Article  PubMed  CAS  Google Scholar 

  12. Schwab J, Zahn R, Bar I (2008) MR tomography presentation of endomyocardial fibrosis as an expression of cardiac involvement in Churg-Strauss syndrome. Rofo 180:55–57

    PubMed  CAS  Google Scholar 

  13. Baccouche H, Yilmaz A, Alscher D, Klingel K, Val-Bernal JF, Mahrholdt H (2008) Images in cardiovascular medicine. Magnetic resonance assessment and therapy monitoring of cardiac involvement in Churg-Strauss syndrome. Circulation 117:1745–1749. doi:10.1161/CIRCULATIONAHA.107.721738

    Article  PubMed  Google Scholar 

  14. Breuckmann K, Breuckmann F, Nassenstein K, Wieneke H, Barkhausen J, Erbel R (2007) MR imaging of endomyocardial fibrosis representing cardiac involvement in Churg-Strauss syndrome. Herz 32:71–72. doi:10.1007/s00059-007-2952-9

    Article  PubMed  Google Scholar 

  15. Alter P, Maisch B (2006) Endomyocardial fibrosis in Churg-Strauss syndrome assessed by cardiac magnetic resonance imaging. Int J Cardiol 108:112–113. doi:10.1016/j.ijcard.2005.02.019

    Article  PubMed  Google Scholar 

  16. Wassmuth R, Göbel U, Natusch A, Schneider W, Kettritz R, Dietz R et al (2008) Cardiovascular magnetic resonance imaging detects cardiac involvement in Churg-Strauss Syndrome. J Card Fail 14:856–860. doi:10.1016/j.cardfail.2008.07.227

    Article  PubMed  Google Scholar 

  17. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 33:1094–1100

    PubMed  CAS  Google Scholar 

  18. Laissy JP, Hyafil F, Feldman LJ, Juliard JM, Schouman-Claeys E, Steg PG et al (2005) Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology 237:75–82. doi:10.1148/radiol.2371041322

    Article  PubMed  Google Scholar 

  19. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542. doi:10.1161/hc0402.102975

    Article  PubMed  Google Scholar 

  20. Frustaci A, Gentiloni N, Chimenti C, Natale L, Gasbarrini G, Maseri A (1998) Necrotizing myocardial vasculitis in Churg-Strauss syndrome: clinicohistologic evaluation of steroids and immunosuppressive therapy. Chest 114:1484–1489. doi:10.1378/chest.114.5.1484

    Article  PubMed  CAS  Google Scholar 

  21. Pennell DJ (2004) Cardiovascular magnetic resonance and the role of adenosine pharmacologic stress. Am J Cardiol 94:26D–31D. doi:10.1016/j.amjcard.2004.04.015 discussion 31D–32D

    Article  PubMed  Google Scholar 

  22. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E (2008) Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 10:35. doi:10.1186/1532-429X-10-35

    Article  PubMed  Google Scholar 

  23. Kellman P, Aletras AH, Hsu LY, McVeigh ER, Arai AE (2006) T2* measurement during first-pass contrast-enhanced cardiac perfusion imaging. Magn Reson Med 56:1132–1134. doi:10.1002/mrm.21061

    Article  PubMed  Google Scholar 

  24. Di Bella EV, Parker DL, Sinusas AJ (2005) On the dark rim artifact in dynamic contrast-enhanced MRI myocardial perfusion studies. Magn Reson Med 54:1295–1299. doi:10.1002/mrm.20666

    Article  PubMed  CAS  Google Scholar 

  25. Wilke N, Jerosch-Herold M, Wang Y, Huang Y, Christensen BV, Stillman AE et al (1997) Myocardial perfusion reserve: assessment with multisection, quantitative, first-pass MR imaging. Radiology 204:373–384

    PubMed  CAS  Google Scholar 

  26. De Cobelli F, Pieroni M, Esposito A, Chimenti C, Belloni E, Mellone R et al (2006) Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J Am Coll Cardiol 47:1649–1654. doi:10.1016/j.jacc.2005.11.067

    Article  PubMed  Google Scholar 

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Correspondence to Andreas Hansch.

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Hansch, A., Pfeil, A., Rzanny, R. et al. First-pass myocardial perfusion abnormalities in Churg-Strauss Syndrome with cardiac involvement. Int J Cardiovasc Imaging 25, 501–510 (2009). https://doi.org/10.1007/s10554-009-9457-y

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  • DOI: https://doi.org/10.1007/s10554-009-9457-y

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