10,11 The reference standard for diagnosis relies on endomyocardial biopsy, which is usually reserved for severe cases. 9 However, cardiac MRI is not available in all centers. 7,8 The diagnosis of myocarditis is usually established after ruling out coronary artery disease by means of coronary angiography or computed tomography and confirming the presence of Lake Louise criteria on cardiac magnetic resonance imaging (MRI). Myocarditis is a frequent final diagnosis in patients who receive an initial diagnosis of acute myocardial infarction with nonobstructive coronary arteries (MINOCA), 6 a clinical entity that occurs in approximately 10 to 20% of patients who meet the criteria for myocardial infarction. 5 The actual prevalence of the disease remains uncertain because of the difficulty of reaching a confirmatory diagnosis in many cases. Myocarditis is a disease with multiple causes 1,2 (e.g., infectious pathogens, toxins, drugs, and autoimmune disorders 3,4) that may resolve spontaneously, cause sudden cardiac death, or evolve into dilated cardiomyopathy. (Funded by the Spanish Ministry of Science and Innovation and others.) Introduction ConclusionsĪfter identifying a microRNA in mice with myocarditis, we found that a novel human noncoding RNA (hsa-Chr8:96) with a similar sequence is associated with myocarditis in patients. The association between hsa-Chr8:96 and myocarditis remained after adjustment for age, sex, ejection fraction, and serum troponin level. The area under the receiver-operating-characteristic curve for this novel RNA for distinguishing patients with acute myocarditis from those with myocardial infarction was 0.927 (95% confidence interval, 0.879 to 0.975). A homologous human small noncoding RNA, designated hsa-Chr8:96, was identified in four independent cohorts of patients with myocarditis. We found that mmu-miR-721 was synthesized by Th17 cells and was present in the plasma of mice with acute autoimmune or viral myocarditis but not in those with acute myocardial infarction. We confirmed that Th17 cells, which are characterized by the production of interleukin-17, are a characteristic feature of myocardial injury in the acute phase of myocarditis. We then identified a human noncoding RNA with high sequence similarity to mmu-miR-721 (we infer it to be a homologue) and compared its expression in plasma obtained from patients with acute myocarditis with the expression in various controls. We also performed RT-qPCR in samples from coxsackievirus-induced myocarditis in mice. To identify a microRNA specific for myocarditis, we performed microRNA microarray analyses and reverse-transcriptase–quantitative polymerase-chain-reaction (RT-qPCR) assays in sorted CD4+ T cells and type 17 helper T (Th17) cells after inducing experimental autoimmune myocarditis or myocardial infarction in mice. We sought to identify a novel microRNA for the diagnosis of acute myocarditis. Additional approaches to diagnosis are desirable. The diagnosis of acute myocarditis typically requires either endomyocardial biopsy (which is invasive) or cardiovascular magnetic resonance imaging (which is not universally available). Original Article A Novel Circulating Noncoding Small RNA for the Detection of Acute Myocarditis List of authors. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. ![]() ![]() The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. ![]() The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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