Abstract
BackgroundThe natural history of acute myocarditis (AM) remains highly variable and predictors of outcome are largely unknown. The objectives were to determine the potential value of various cardiovascular magnetic resonance (CMR) parameters for the prediction of adverse long-term outcome in patients presenting with suspected AM.MethodsIn a single-centre longitudinal prospective study, 203 routine consecutive patients with an initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were followed over a mean period of 18.9 ± 8.2 months. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined Major Adverse Clinical Events (MACE) (cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes).ResultsThe vast majority of patients (N = 143,70 %) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3 ± 2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2 CMR, and extent of late gadolinium enhancement lesions). Out of the 203 patients, 22 experienced at least one major cardiovascular event (10.8 %) during follow-up for a total of 31 major cardiovascular events. Among all CMR parameters, the only independent CMR predictor of adverse clinical outcome by multivariate analysis was an initial alteration of LVEF (p = 0.04).ConclusionsIn routine consecutive patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence and extent of myocardial edema and the extent of late gadolinium-enhanced LV myocardial lesions were not predictive of outcome. The only independent CMR predictor of adverse clinical outcome was an initial alteration of LVEF.
Highlights
The natural history of acute myocarditis (AM) remains highly variable and predictors of outcome are largely unknown
It has been recognized in pathologic studies to be associated with 8.6 to 12 % of sudden cardiac deaths [3, 4], and up to 9 % of dilated cardiomyopathy [1, 5, 6], its clinical presentation is less severe in the vast majority of the cases and heart failure is uncommon. [7,8,9] Because the natural history of AM remains highly variable, the prognostic stratification is of critical importance
The aim of this study was to investigate the potential value of various cardiovascular magnetic resonance (CMR) parameters for the prediction of adverse long-term outcome in patients presenting with suspected AM in routine practice
Summary
The natural history of acute myocarditis (AM) remains highly variable and predictors of outcome are largely unknown. At the acute stage of AM, several predictors of outcome have been postulated such as ventricular dysfunction [7, 9], advanced New York Heart Association class [15, 16], elevated pulmonary artery pressure [16], prolonged QRS duration [17], specific histopathological forms or patterns of tissue damage [18, 19], increased myocardial early gadolinium enhancement ratio [20], or presence of late gadolinium enhancement [21] These predictors are still controversial [1, 9], and in particular those extracted from CMR. The aim of this study was to investigate the potential value of various CMR parameters for the prediction of adverse long-term outcome in patients presenting with suspected AM in routine practice
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