ABSTRACT
Background: The diagnosis of myocarditis remains challenging due to its diverse clinical manifestations. We recently demonstrated the ability of magnetocardiography (MCG) to screen for myocarditis and applied it successfully to detect myocarditis in this case study of a female-to-male (FtM) patient who had undergone sexual reassignment surgery. This case highlights two significant points: first, sex differences in myocarditis may be promoted by higher levels of testosterone, and second, the ability of MCG to diagnose myocarditis. Case presentation: We report on a 38-year-old FtM patient who was hospitalized for chest pain following testosterone therapy. The patient received testosterone every 2 weeks for 6 months following his FtM surgery. Two days after the last administration of testosterone, he developed chest pain. Electrocardiography identified non-significant ST elevations in V3-6, II and aVF and echocardiography revealed reduced left ventricular ejection fraction and apical hypokinesia. High-sensitivity troponin-T (539 ng/L to 676 ng/L) and creatine kinase elevation (592 U/L) were elevated. Coronary CT angiography ruled out coronary artery disease. Cardiac magnetic resonance imaging confirmed suspected myocarditis.Additionally, we used MCG to detect abnormalities in the electromagnetic field. A pathologic vector (0.179) supported the diagnosis of myocarditis in this patient. During therapy with ibuprofen the vector improved to 0.067 after 3 weeks accompanied by symptom improvement. Conclusion: Testosterone treatment may have promoted myocarditis in a FtM individual. Additional MCG assessment was consistent with a diagnosis of myocarditis and highlights the promising potential of this method to facilitate diagnostic screening for cardiomyopathy in the future.
ABSTRACT
Background: The diagnosis of inflammatory cardiomyopathies remains challenging. Life-threatening conditions such as acute coronary syndrome (ACS) always have to be considered as differential diagnoses due to similarities in presentation. Diagnostic methods for inflammatory cardiomyopathy include endomyocardial biopsy (EMB), cardiac magnetic resonance imaging (CMR), and positron emission tomography-computed tomography (PET-CT). We report a case in whom magnetocardiography (MCG) led to an initial diagnosis of inflammatory cardiomyopathy and in whom MCG was used for subsequent monitoring of treatment response under immunosuppression. Case presentation: A 53-year-old man presented with two recurrent episodes of inflammatory cardiomyopathy within a 2-year period. The patient initially presented with reduced exercise capacity. Echocardiography revealed a moderately reduced left ventricular ejection fraction (LVEF 40%). Coronary angiography ruled out obstructive coronary artery disease (CAD) and an EMB was performed. The EMB revealed inflammatory cardiomyopathy without viral pathogens or replication. Moreover, we performed MCG, which confirmed a pathological Tbeg-Tmax vector of 0.108. We recently established a cutoff value of Tbeg-Tmax of 0.051 or greater for the diagnosis of inflammatory cardiomyopathy. Immunosuppressive therapy with prednisolone was initiated, resulting in clinical improvement and an LVEF increase from 40% to 45% within 1 month. Furthermore, the MCG vector improved to 0.036, which is considered normal based on our previous findings. The patient remained clinically stable for 23 months. During a routine follow-up, MCG revealed an abnormal Tbeg-Tmax vector of 0.069. The patient underwent additional testing including routine laboratory values, echocardiography (LVEF 35%), and PET-CT. PET-CT revealed increased metabolism in the myocardium-primarily in the lateral wall. Therapy with prednisolone and azathioprine was initiated and MCG was used to monitor the effect of immunosuppressive therapy. Conclusion: In addition to diagnostic screening, MCG has the potential to become a valuable method for surveillance monitoring of patients who have completed treatment for inflammatory cardiomyopathy. Furthermore, it could be used for treatment monitoring. While changes in the magnetic vector of the heart are not specific to inflammatory cardiomyopathy, as they may also occur in other types of cardiomyopathies, MCG offers a tool of broad and efficient diagnostic screening for cardiac pathologies without side effects.
