More than 50% of Persistent Myocardial Scarring at One Year in "Infarct-like" Acute Myocarditis Evaluated by CMR.

Thibaut Pommier,Maud Maza,Céline Lairet,Yves Cottin,Alain Lalande,Marianne Zeller,Simon Tisserand,Alexandre Cochet,Charles Guenancia,Thibault Leclercq,Max Carré,Florence Bichat

doi:10.3390/jcm10204677

Abstract

Background: Cardiac magnetic resonance (CMR) has emerged as a reference tool for the non-invasive diagnosis of myocarditis. However, its role in follow-up (FU) after the acute event is unclear. The objectives were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter and to identify the predictive factors of persistent myocardial scarring at one year. Methods: All patients with infarct-like acute myocarditis confirmed by CMR were included. CMR was performed within 8 days following symptom onset, at 3 months and at one year. One-year FU included ECG, a cardiac stress test, Holter recording, biological assessments, medical history and a quality-of-life questionnaire. Patients were classified according to the presence or absence of complete recovery at one year based on the CMR evaluation. Results: A total of 174 patients were included, and 147 patients had three CMR. At one year, 79 patients (54%) exhibited persistent myocardial scarring on CMR. A multivariate analysis showed that high peak troponin at the acute phase (OR: 3.0—95%CI: 1.16–7.96—p = 0.024) and the initial extent of late gadolinium enhancement (LGE) (OR: 1.1—95%CI: 1.03–1.19—p = 0.006) were independent predictors of persistent myocardial scarring. Moreover, patients with myocardial scarring on the FU CMR were more likely to have premature ventricular contractions during the cardiac stress test (25% versus 9%, p = 0.008). Conclusion: Less than 50% of patients with infarct-like acute myocarditis showed complete recovery at one year. Although major adverse cardiac events were rare, ventricular dysrhythmias at one year were more frequent in patients with persistent myocardial scarring.

Highlights

Myocarditis is an inflammatory disease with a variable course, ranging from complete remission to severe complications [1]
The most common cause of myocarditis is viral infection, other causes comprise systemic or toxic diseases [3]. The prognosis of this disease is rather good with spontaneous clinical healing in many patients. Complications may occur such as sudden cardiac death (SCD) [4] or dilated cardiomyopathy (DCM) [5] and myocarditis remains in young patients a major cause of deaths
We found that more than 50% of patients with infarct-like myocarditis evidenced the absence of complete recovery at one year

Summary

Introduction

Myocarditis is an inflammatory disease with a variable course, ranging from complete remission to severe complications [1]. Myocarditis remains a difficult diagnosis because of the various clinical presentations: infarct-like syndrome, acute or chronic heart failure, cardiac arrhythmia or cardiogenic shock [2]. The prognosis of this disease is rather good with spontaneous clinical healing in many patients. The objectives were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter and to identify the predictive factors of persistent myocardial scarring at one year. Methods: All patients with infarct-like acute myocarditis confirmed by CMR were included. CMR was performed within 8 days following symptom onset, at 3 months and at one year. Patients were classified according to the presence or absence of complete recovery at one year based on the CMR evaluation.

Objectives

Methods

Results

Discussion

Conclusion