Prognostic Value of Repeating Cardiac Magnetic Resonance in Patients With Acute Myocarditis
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Author + information
- Giovanni Donato Aquaro, MDa,∗ (aquaro{at}ftgm.it),
- Yacob Ghebru Habtemicael, MDa,
- Giovanni Camastra, MDb,
- Lorenzo Monti, MDc,
- Santo Dellegrottaglie, MDd,e,
- Claudio Morof,
- Chiara Lanzillo, MDg,
- Alessandra Scatteia, MDh,
- Mauro Di Roma, MDi,
- Gianluca Pontone, MDj,
- Martina Perazzolo Marrak,
- Andrea Barison, MDa,
- Gianluca Di Bellal,
- on behalf of the “Cardiac Magnetic Resonance” Working Group of the Italian Society of Cardiology
- aFondazione Toscana G.Monasterio, Pisa, Italy
- bCardiac Department, Vannini Hospital Rome, Roma, Italy
- cRadiology Department, Humanitas Research Hospital, I.R.C.C.S., Rozzano, Milan, Italy
- dDivision of Cardiology, Villa dei Fiori, Acerra, Napoli, Italy
- eMount Sinai School of Medicine, New York, New York
- fU.O. Cardiologia e UTIC, ASST Monza, P.O. Desio, Desio, Italy
- gCardiology Department, Policlinico Casilino, Rome, Italy
- hDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- iRadiological Department, European Hospital, Roma, Italy
- jCardiac Department, Centro Cardiologico Monzino, Milano, Italy
- kDivision of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
- lClinical and Experimental Department of Medicine, University of Messina, Messina, Italy
- ↵∗Address for correspondence:
Dr. Giovanni Donato Aquaro, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
Central Illustration
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.
Footnotes
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Dudley Pennell, MD, served as Guest Associate Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 9, 2019.
- Revision received August 29, 2019.
- Accepted August 30, 2019.
- 2019 American College of Cardiology Foundation
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