BACKGROUND Cardiac magnetic resonance (CMR) is widely used to confirm the diagnosis of acute myocarditis (AM) in the acute setting. CMR is often repeated after 6 months to assess the evolution of myocardial involvement. However, the clinical and prognostic role of 6-month CMR is unknown.OBJECTIVES This multicenter study aimed to evaluate the clinical and prognostic role of 6-month repetition of CMR in patients with AM.METHODS In a subgroup of 187 patients from the ITAMY (ITAlian study in MYocarditis) registry, CMR was performed within the first week after symptom onset (CMR-I) and repeated after 6 months (CMR-II).RESULTS Myocardial edema was detected in all the patients at CMR-I and persisted in 31 (16%) at CMR-II. LGE was detected in 182 (96%) patients at CMR-I and in 164 (86%) at CMR-II. At CMR-II, 20 (11%) patients presented a complete recovery from edema and LGE, 30 (16%) patients had edema with LGE, and 137 (73%) presented LGE without edema. LGE disappeared completely in 18 (10%) patients, the number of LGE segments decreased in 87 (46%), unchanged in 58 (31%), and increased in 26 (14%). During a median clinical follow-up of 7 years (25th to 75th percentile: 6 to 8 years) cardiac events occurred in 22 patients. At Kaplan-Meier curves, patients with LGE and without edema had worse prognosis than others (p < 0.0001). Patients with increased extent of LGE (p = 0.02) had a worse prognosis than those with decreased/unchanged LGE. At multivariate Cox regression analysis, the midwall septal pattern of LGE and the presence of LGE without edema at CMR-II were independent predictors of a cardiac event.CONCLUSIONS In the acute setting, LGE does not mean definite fibrosis, and it may disappear at 6 months. The presence of LGE without edema at 6-month CMR is associated with worse prognosis, particularly when distributed with a midwall septal pattern. LGE without edema could represent definite fibrosis whereas the presence of edema suggests a residual chance of recovery. (J Am Coll Cardiol 2019;74:2439-48) (c) 2019 by the American College of Cardiology Foundation.

Prognostic Value of Repeating Cardiac Magnetic Resonance in Patients With Acute Myocarditis / G.D. Aquaro, Y. Ghebru Habtemicael, G. Camastra, L. Monti, S. Dellegrottaglie, C. Moro, C. Lanzillo, A. Scatteia, M. Di Roma, G. Pontone, M. Perazzolo Marra, A. Barison, G. Di Bella. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 1558-3597. - 74:20(2019 Nov 19), pp. 2439-2448. [10.1016/j.jacc.2019.08.1061]

Prognostic Value of Repeating Cardiac Magnetic Resonance in Patients With Acute Myocarditis

G. Pontone;
2019

Abstract

BACKGROUND Cardiac magnetic resonance (CMR) is widely used to confirm the diagnosis of acute myocarditis (AM) in the acute setting. CMR is often repeated after 6 months to assess the evolution of myocardial involvement. However, the clinical and prognostic role of 6-month CMR is unknown.OBJECTIVES This multicenter study aimed to evaluate the clinical and prognostic role of 6-month repetition of CMR in patients with AM.METHODS In a subgroup of 187 patients from the ITAMY (ITAlian study in MYocarditis) registry, CMR was performed within the first week after symptom onset (CMR-I) and repeated after 6 months (CMR-II).RESULTS Myocardial edema was detected in all the patients at CMR-I and persisted in 31 (16%) at CMR-II. LGE was detected in 182 (96%) patients at CMR-I and in 164 (86%) at CMR-II. At CMR-II, 20 (11%) patients presented a complete recovery from edema and LGE, 30 (16%) patients had edema with LGE, and 137 (73%) presented LGE without edema. LGE disappeared completely in 18 (10%) patients, the number of LGE segments decreased in 87 (46%), unchanged in 58 (31%), and increased in 26 (14%). During a median clinical follow-up of 7 years (25th to 75th percentile: 6 to 8 years) cardiac events occurred in 22 patients. At Kaplan-Meier curves, patients with LGE and without edema had worse prognosis than others (p < 0.0001). Patients with increased extent of LGE (p = 0.02) had a worse prognosis than those with decreased/unchanged LGE. At multivariate Cox regression analysis, the midwall septal pattern of LGE and the presence of LGE without edema at CMR-II were independent predictors of a cardiac event.CONCLUSIONS In the acute setting, LGE does not mean definite fibrosis, and it may disappear at 6 months. The presence of LGE without edema at 6-month CMR is associated with worse prognosis, particularly when distributed with a midwall septal pattern. LGE without edema could represent definite fibrosis whereas the presence of edema suggests a residual chance of recovery. (J Am Coll Cardiol 2019;74:2439-48) (c) 2019 by the American College of Cardiology Foundation.
acute myocarditis; cardiac magnetic resonance; late gadolinium enhancement; myocardial edema; prognosis
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
19-nov-2019
Article (author)
File in questo prodotto:
File Dimensione Formato  
2019 JACC (Prognostic value of repeating CMR in myocarditis).pdf

accesso riservato

Descrizione: Original Investigation
Tipologia: Publisher's version/PDF
Dimensione 1.18 MB
Formato Adobe PDF
1.18 MB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/955567
Citazioni
  • ???jsp.display-item.citation.pmc??? 65
  • Scopus 154
  • ???jsp.display-item.citation.isi??? 140
social impact