Acute Coronary Syndrome or Myocarditis The Role of Multimodality Imaging

In patients presenting with chest pain, abnormal ECG and raised troponin to emergency department, myocarditis may be suspected after normal coronary angiography. Currently, no single clinical or imaging modality confirms the diagnosis of myocarditis with absolute certainty. Endomyocardial biopsy is not appropriate in many patients especially in less severe disease. There are different imaging modality to evaluate myocarditis in this condition. Cardiac magnetic resonance (CMR), scintigraphy and echocardiography are the main tools to evaluate myocarditis. During last decade, CMR gained a major role in diagnostic approach of acute and chronic myocarditis and its accuracy and sensitivity especially during acute and chronic phase was evaluated in multiple recent studies. These studies showed that time is an important factor to perform CMR in myocarditis. Furthermore new CMR techniques including T1 and T2 mapping and extracellular volume (ESV) quantification methods increased sensitivity of CMR. Echocardiography is a standard approach to these patients, but it’s sensitivity and accuracy to confirm or rule out myocarditis is under question. Newer echocardiography modality such as strain echocardiography which is reflected in few recent studies’ is promising.Nowadays Scintigraphy role is decreased and it may be considered only for special condition.