Multimodality cardiac imaging in Clozapine-induced eosinophilic constrictive perimyocarditis.

tion of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. of dynamic computed tomography adenosine stress myocardial perfusion imaging in estimating myocardial blood flow at various degrees of coronary artery stenosis using a porcine animal model. A et al. Computed tomography stress myocardial perfusion imaging in patients considered for revas-cularization: a comparison with fractional flow reserve. Diagnostic performance of combined noninvasive coronary angiography and myo-cardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study. Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Adenosine-stress dynamic myocardial CT perfusion imaging: initial clinical experience. Stress and rest dynamic myocardial perfu-sion imaging by evaluation of complete time-attenuation curves with dual-source CT. Adenosine stress 64-and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. A 21-year-old patient started recently on Clozapine presented with chest pain, ECG changes, eosinophilia, and raised TnT. Echocardiography showed a small pericardial effusion with thickened pericardium and a striking poster-olateral echo-bright area, without clear delineation between fibrin clot and subepicardial inflammatory process (Panel A). Mitral velocities showed respiratory variations suggestive of constriction (Panel B). LV contractility was preserved but longitudinal velocities were reduced (Panel C) and borderline values of mitral annular displacement (MAD) by speckle tracking suggested systolic dysfunction (Panel D). Cardiac MRI confirmed mild systolic dysfunction (LVEF ¼ 50%). Contrast enhanced, T1-weighted-delayed enhancement (Panel E), delineated high signal intensity band in the pericardium and adjacent epicardium consistent with perimyocarditis with spared endocardium, and mid-myocardium. BTFE cine image (Panel F) showed the true relative thickness of the myocardium and the pericardium. One week after stopping the Clozapine the eosinophilia resolved. Repeat echocardiogram showed no change to the inflammatory features (Panel G), but the mitral respiratory variations had disappeared, suggestive of resolving constriction (Panel H), and there was normalization of longitudinal velocities (Panel I) and MAD (Panel J). The diagnosis of Clozapine myocarditis relies on clinical presentation, imaging, and endomyocardial biopsy. In this case, multimodality imaging was used and allowed the diagnosis of constrictive perimyocarditis. Echocardiog-raphy showed pericarditis with a constrictive element and revealed infraclini-cal myocardial dysfunction consistent with myocarditis. On repeat study, tissue-Doppler and speckle tracking demonstrated that functional recovery before any obvious change in the inflammatory infiltrate was …