Zusammenfassung
Die Myokarditis ist eine häufige Erkrankung aller Altersgruppen. Die korrekte Diagnostik der Myokarditis ist schwierig, aber von klinischer und wissenschaftlicher Bedeutung. Ziel dieser Übersichtsarbeit ist es daher, die diagnostischen Möglichkeiten darzustellen und zu bewerten.
Weder durch ein EKG noch durch Laboruntersuchungen oder die Echokardiographie kann eine Myokarditis eindeutig diagnostiziert werden. Auch mittels nuklearmedizinischer Techniken oder Koronarangiographie lässt sich eine Myokarditis nicht sichern.
Eindeutig kann eine Myokarditis nur mittels Endomyokardbiopsie diagnostiziert werden. Um eine maximale Sensitivität der Myokardbiopsie zu erreichen, muss das Biopsat histologisch, immunhistologisch und molekular-pathologisch aufgearbeitet werden. Auch bei optimaler Aufarbeitung des Biopsats verbleibt allerdings das Problem des „sampling errors”. Hinzu kommt, dass die Myokardbiopsie trotz einer niedrigen Komplikationsrate in der Praxis nur selten eingesetzt wird, so dass die Myokarditis oft eine Vermutungsdiagnose bleibt.
Die Limitationen der bisher verwendeten Standardverfahren machen die kardiale MR (CMR) zu einem wertvollen neuen Zusatzinstrument bei klinischem Verdacht auf Myokarditis. Bei Patienten mit kardialen Symptomen und für die Myokarditistypischen CMR-Befunden findet sich sehr oft auch bioptisch eine Myokarditis, insbesondere wenn die Entnahme der Endomyokardbiopsien in räumlicher Nähe zu mittels CMR dargestellten Kontrastanreicherungen erfolgt. Zusätzlich kann mittels CMR eine nicht-invasive und risikoarme Verlaufskontrolle der funktionellen Parameter und der Gewebsschäden erfolgen.
Summary
Myocarditis is a common disease in all age groups. Correct diagnosis of myocarditis is difficult, but of clinical and scientific importance. It is the aim of this review to describe and evaluate diagnostic possibilities.
It is not possible to make a definitive diagnosis of myocarditis by electrocardiography, laboratory tests or echocardiography. Nor can techniques of nuclear medicine or coronary angiography provide an unequivocal diagnosis of myocarditis. Myocarditis can be diagnosed with certainty only by endomyocardial biopsy, which must be examined by histological, immunohistological and molecular techniques to obtain maximal sensitivity. But optimal diagnosis of a biopsy is subject to the problem of sampling error. Furthermore, myocardial biopsy is in practice used only rarely, despite a low complication rate. Thus the diagnosis of myocarditis is often based merely on suspicion. The limitations of standard methods employed so far have made cardiac magnetic resonance imaging (CMR) a valuable new additional test when there is the clinical suspicion of myocarditis. A myocardial biopsy will often reveal myocarditis in patients with cardiac symptoms and CMRI findings typical of myocarditis, especially if the biopsy was obtained near the area of contrast enhancement in the CMRI. CMRI can also be used for noninvasive and low-risk follow-up of functional parameters and tissue damage.
Schlüsselwörter
Myokarditis - Kardiomyopathie - Kardiale MRT
Key words
Myocarditis - cardiomyopathy - cardiac MRT
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Prof. Dr. U. Sechtem
Abteilung für Kardiologie, Robert-Bosch-Krankenhaus
Auerbachstraße 110
70376 Stuttgart
Telefon: 0711/81013456
Fax: 0711/81013790
eMail: Udo.Sechtem@rbk.de
