Magnetic Resonance Assessment and Therapy Monitoring of Cardiac

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Magnetic Resonance Assessment and Therapy Monitoring of Cardiac Involvement in Churg-Strauss Syndrome by Hannibal Baccouche, AliMagnetic Resonance Assessment and Therapy Monitoring of Cardiac Involvement in Churg-Strauss Syndrome by Hannibal Baccouche, Ali Yilmaz, Dominik Alscher, Karin Klingel, Jose Fernando Val-Bernal, and Heiko Mahrholdt Circulation Volume 117(13): 1745 -1749 April 1, 2008 Copyright © American Heart Association

Figure 1. Twelve-lead ECG obtained at initial presentation in our emergency room, demonstrating ST-abnormalities suspicious forFigure 1. Twelve-lead ECG obtained at initial presentation in our emergency room, demonstrating ST-abnormalities suspicious for perimyocarditis. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 2. Frontal posterior–anterior chest x-ray on admission. Baccouche H et al. Circulation 2008; 117:Figure 2. Frontal posterior–anterior chest x-ray on admission. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 3. Transthoracic echocardiogram (TTE) after chest x-ray. Baccouche H et al. Circulation 2008; 117:Figure 3. Transthoracic echocardiogram (TTE) after chest x-ray. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 4. CMR study at initial presentation. Baccouche H et al. Circulation 2008; 117: 1745Figure 4. CMR study at initial presentation. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 5. Histopathological work-up of LV endomoycardial biopsy specimen (Giemsa staining), displaying normal myocytes (A),Figure 5. Histopathological work-up of LV endomoycardial biopsy specimen (Giemsa staining), displaying normal myocytes (A), numerous infiltrating clusters of eosinophilic granulocytes (B, revealing red cytoplasmic granules), fibrosis (C, curly collagen fibe. . . Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 6. Short-axis contrast CMR image from the current patient compared with a necropsy sample ofFigure 6. Short-axis contrast CMR image from the current patient compared with a necropsy sample of a different patient who died suddenly from Churg-Strauss syndrome with cardiac involvement. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 7. Follow-up CMR after 2 months of immunosuppressive therapy using the same CMR protocol asFigure 7. Follow-up CMR after 2 months of immunosuppressive therapy using the same CMR protocol as described above. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 8. Quantitative plot visualizing the extent of late gadolinium enhancement before (left panel) and afterFigure 8. Quantitative plot visualizing the extent of late gadolinium enhancement before (left panel) and after 2 months of immunosuppressive treatment (right panel) as gray-scale maps representing signal intensity in the American Heart Association/American. . . Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association

Figure 9. Twelve-lead ECG obtained 6 months after initiation of immunosuppressive treatment, demonstrating a decreaseFigure 9. Twelve-lead ECG obtained 6 months after initiation of immunosuppressive treatment, demonstrating a decrease in ST abnormalities. Baccouche H et al. Circulation 2008; 117: 1745 -1749 Copyright © American Heart Association