A real-life clinical application of cardiac magnetic resonance imaging in patients with acute myocarditis — one-center observational retrospective study
Abstract
Background: The diagnosis of acute myocarditis is complex, with cardiac magnetic resonance (CMR) being a recommended diagnostic method. This study aimed to evaluate the real-life use of CMR in the diagnosis of acute myocarditis and to correlate CMR results with the degree of myocardial damage.
Methods: This is a retrospective, observational tertiary single-center study of 90 consecutive patients (F/M:18/72, mean age:39 ± 14 years) hospitalized between 2015–2022 with a clinical diagnosis of acute myocarditis. The study population was divided into two groups: patients who underwent CMR+ and those who did not undergo CMR – In the CMR+ group, various sequences, including T1/T2-weighted imaging, late gadolinium enhancement (LGE), and mapping techniques, were used to assess myocardial inflammation and damage.
Results: CMR was performed in 39 patients (43.3%, F/M:10/29, mean age:41 ± 16 years). In this group, myocardial edema (increased T2 signal intensity) was detected in 29 patients, and LGE (signal intensity 2 standard deviations cabove normal on T1 images) was found in 39 patients. Diagnosis based on Lake Louise Criteria was possible in 29 cases. Edema negatively correlated with TnT levels (r = –0.412, p < 0.05) and positively with the number of LGE segments (r = 0.372, p < 0.05). Significant correlations were found between LVEF and LGE mass (r = –0.360, p < 0.05), and maximal TnT levels (r = –0.38, p < 0.05). CMR+ patients had lower myocardial damage markers and CRP concentrations compared to CMR– patients.
Conclusions: CMR is underused in diagnosing acute myocarditis. Myocardial damage markers correlate with CMR-detected edema and volumetric measures, but not LGE extent. More research is needed to enhance risk assessment and treatment.
Keywords: acute myocarditiscardiac magnetic resonancelate gadolinium enhancementregion of interest massLake Louise Criteria
References
- Ammirati E, Frigerio M, Adler ED, et al. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail. 2020; 13(11): e007405.
- Eichhorn C, Greulich S, Bucciarelli-Ducci C, et al. Multiparametric Cardiovascular Magnetic Resonance Approach in Diagnosing, Monitoring, and Prognostication of Myocarditis. JACC Cardiovasc Imaging. 2022; 15(7): 1325–1338.
- Seetharam K, Lerakis S. Cardiac magnetic resonance imaging: the future is bright. F1000Res. 2019; 8.
- Wiligórska N, Wiligórska D, Pawlak A. Pawlak A. Zapalenie mięśnia sercowego Kardiol Inwazyjna. 2017; 12(3): 47–58.
- Imran M, Wang L, McCrohon J, et al. Native T Mapping in the Diagnosis of Cardiac Allograft Rejection: A Prospective Histologically Validated Study. JACC Cardiovasc Imaging. 2019; 12(8 Pt 2): 1618–1628.
- Zapolski T, Haratym-Zwolak A, Wysokiński A. Współczesne zasady diagnostyki zapalenia mięśnia sercowego i kardiomiopatii pozapalnej. Folia Cardiologica. 2015; 10(4): 259–267.
- Luetkens JA, Faron A, Isaak A, et al. Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort. Radiol Cardiothorac Imaging. 2019; 1(3): e190010.
- Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol. 2018; 72(24): 3158–3176.
- Ammirati E, Veronese G, Bottiroli M, et al. Update on acute myocarditis. Trends Cardiovasc Med. 2021; 31(6): 370–379.
- Olejniczak M, Schwartz M, Webber E, et al. Viral Myocarditis-Incidence, Diagnosis and Management. J Cardiothorac Vasc Anesth. 2020; 34(6): 1591–1601.
- Lampejo T, Durkin SM, Bhatt N, et al. Acute myocarditis: aetiology, diagnosis and management. Clin Med (Lond). 2021; 21(5): e505–e510.
- Caforio ALP, Pankuweit S, Arbustini E, et al. European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013; 34(33): 2636–48, 2648a.
- Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol. 2018; 72(24): 3158–3176.
- Sadahiro T, Kohsaka S, Okuda S, et al. MRI and serum high-sensitivity C reactive protein predict long-term mortality in non-ischaemic cardiomyopathy. Open Heart. 2015; 2(1): e000298.
- Berlot B, Harries I, Bucciarelli-Ducci C. Connection between the heart and the gut. Heart. 2019; 105(15): 1148–1196.
- Mewton N, Dernis A, Bresson D, et al. Myocardial biomarkers and delayed enhanced cardiac magnetic resonance relationship in clinically suspected myocarditis and insight on clinical outcome. J Cardiovasc Med (Hagerstown). 2015; 16(10): 696–703.
- Gräni C, Eichhorn C, Bière L, et al. Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis. J Am Coll Cardiol. 2017; 70(16): 1964–1976.
- Gräni C, Bière L, Eichhorn C, et al. Incremental value of extracellular volume assessment by cardiovascular magnetic resonance imaging in risk stratifying patients with suspected myocarditis. Int J Cardiovasc Imaging. 2019; 35(6): 1067–1078.
- Schumm J, Greulich S, Wagner A, et al. Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis. J Cardiovasc Magn Reson. 2014; 16(1): 14.
- Aquaro G, Perfetti M, Camastra G, et al. Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function. Journal of the American College of Cardiology. 2017; 70(16): 1977–1987.
- Grün S, Schumm J, Greulich S, et al. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol. 2012; 59(18): 1604–1615.
- Bradham WS, Bell SP, Adkisson DW, et al. Myocardial T1 Measurement Predicts Beneficial LV Remodeling After Long-Term Heart Failure Therapy. J Card Fail. 2017; 23(3): 262–265.
