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Ferumoxytol in acute myocarditis: ‘keep your head in the clouds and your feet on the earth’
  1. Sophie I Mavrogeni1,
  2. George Markousis-Mavrogenis2,
  3. Genovefa Kolovou2
  1. 1 Onassis Cardiac Surgery Center, Athens, Greece
  2. 2 Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
  1. Correspondence to Dr Sophie I Mavrogeni, Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P.Faliro, Athens, Greece; soma13{at}otenet.gr

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Oedema-fibrosis imaging, as documented using the Lake Louise criteria,1 is the currently established approach for evaluating acute myocarditis with cardiovascular magnetic resonance (CMR). Imaging these pathophysiological phenomena requires making use of CMR sequences based on paramagnetic gadolinium-based contrast agents; however, normal renal function is a necessary prerequisite for the administration of gadolinium-based agents.1 Ultrasmall superparamagnetic particles of iron oxide (USPIO) are a novel type of paramagnetic contrast agent that consists of an iron oxide core surrounded by a carbohydrate or polymer coating. The sufficiently small size of USPIO allows them to passively diffuse through the fenestrae of capillary endothelia, thus reaching the vicinity of resident tissue macrophages which in turn engulf them; USPIO are detectable with T2*-weighted CMR sequences. Ferumoxytol, a USPIO agent, has been proposed as an effective non-gadolinium paramagnetic contrast agent for CMR because of its effectiveness in shortening T1 and T2 relaxation times. Also of clinical significance is the fact that it may constitute an alternative for patients with impaired renal function but in dire need of contrast-enhanced CMR. Experimental and clinical studies have already demonstrated its overall safety with only rare occurrences of anaphylactoid reactions.2

USPIO-enhanced MRI can identify tissue macrophage activity and by extension …

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