LIÊN QUAN GIỮA NỒNG ĐỘ TROPONIN T VỚI HÌNH ẢNH CỘNG HƯỞNG TỪ TIM Ở BỆNH NHÂN VIÊM CƠ TIM CẤP

Abstract

Background: Cardiac MR criteria for acute myocarditis (Lake Louise Criteria 2018) include scarring as defined by high-signal- intensity areas in late gadolinium enhancement (LGE), and inflammatory markers as defined by an increased early contrast uptake (early gadolinium enhancement, EGE) and edema (increased signal intensity in T2 signal weighted images). Troponin is a widely used clinical marker for cardiomyocyte death; however, the relationship between biochemical markers of myocardial injury and these imaging features has not been clearly established. Objective: To determine the relationship between biochemical marker hs Troponin T of myocardial injury in acute myocarditis and the cardiac magnetic resonance (MR) imaging features. Methods: Fifty-three patients who had troponin-T levels measured at presentation and had the diagnosis of acute myocarditis based on clinical factors and cardiac MR criteria “Lake Louise Criteria” were evaluated. MR images were based on at least one T1-based criterion (increased myocardial T1 relaxation times, extracellular volume fraction, or LGE) with at least one T2-based criterion (increased myocardial T2 relaxation times, visible myocardial edema, or increased T2 signal intensity ratio). Ordinary least-squared linear regression was used to determine the relationship between these imaging features and peak serum troponin-T concentration in the acute presentation. Results: There was a linear increase between T1 and LGE with hs Troponin T concentrations of R² = 0.2, ß = 2.4, p = 0.002 and R² = 0.08, ß = 899.0, p = 0.045, respectively. ECV index and T2 did not show an association with Troponin T concentration, R² = 0.04, ß = 15.8, p = 0.22 and R² = 0.00, ß = -2.1, p = 0.944, respectively. Conclusions: In the setting of acute myocarditis troponin-T concentrations show the strongest correlation with T1 and LGE. There is no correlation between the ECV and T2. These findings suggest that T1 and LGE specifically reflect irreversible myocardial injury, whereas other CMR criteria appear to reflect processes that are not associated with myocardial necrosis.