Abstract
Cardiovascular magnetic resonance (CMR) is used to investigate suspected acute myocarditis, however most supporting data is retrospective and few studies have included parametric mapping. We aimed to investigate the utility of contemporary multiparametric CMR in a large prospective cohort of patients with suspected acute myocarditis, the impact of real-world variations in practice, the relationship between clinical characteristics and CMR findings and factors predicting outcome. 540 consecutive patients we recruited. The 113 patients diagnosed with myocarditis on CMR performed within 40 days of presentation were followed-up for 674 (504–915) days. 39 patients underwent follow-up CMR at 189 (166–209) days. CMR provided a positive diagnosis in 72% of patients, including myocarditis (40%) and myocardial infarction (11%). In multivariable analysis, male sex and shorter presentation-to-scan interval were associated with a diagnosis of myocarditis. Presentation with heart failure (HF) was associated with lower left ventricular ejection fraction (LVEF), higher LGE burden and higher extracellular volume fraction. Lower baseline LVEF predicted follow-up LV dysfunction. Multiparametric CMR has a high diagnostic yield in suspected acute myocarditis. CMR should be performed early and include parametric mapping. Patients presenting with HF and reduced LVEF require closer follow-up while those with normal CMR may not require it.
Highlights
Cardiovascular magnetic resonance (CMR) is increasingly used to investigate patients with suspected acute myocarditis [1]
This study aimed to investigate the clinical utility of CMR in a large prospective cohort of patients with suspected acute myocarditis
Being male and there being a shorter interval between hospital presentation and CMR were independently associated with a diagnosis of myocarditis on CMR
Summary
Cardiovascular magnetic resonance (CMR) is increasingly used to investigate patients with suspected acute myocarditis [1]. The majority of data supporting the use of CMR for this indication is retrospective, and few studies have included contemporary parametric mapping techniques [2,3,4,5,6,7]. While CMR is included in guidelines and position statements regarding the investigation of suspected myocarditis, the Class of Recommendation varies and it is with Level of Evidence C, i.e., “consensus of opinion of the experts and or small studies, retrospective studies, registries” [1,8,9]. This study aimed to investigate the clinical utility of CMR in a large prospective cohort of patients with suspected acute myocarditis. The study aimed to evaluate the impact that real-world variations in practice have on CMR findings, the relationship between clinical characteristics and CMR findings and factors that predict outcome
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