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. 2022 Jan 10;12(1):156.
doi: 10.3390/diagnostics12010156.

The Diagnostic and Prognostic Utility of Contemporary Cardiac Magnetic Resonance in Suspected Acute Myocarditis

Jakub Lagan  1   2 , Christien Fortune  1   2 , David Hutchings  1   2 , Joshua Bradley  1   2 , Josephine H Naish  2 , Richard Timoney  3 , Daniel Prescott  4 , Hamish D C Bain  5 , Tasneem Bangi  6   7 , Jerome McIntosh  6 , Robin Egdell  8 , R Bruce Irwin  9 , David Clark  1 , Erik B Schelbert  10   11 , Gaetano Nucifora  1 , Matthias Schmitt  1   2 , Christopher A Miller  1   2   12
Affiliations

The Diagnostic and Prognostic Utility of Contemporary Cardiac Magnetic Resonance in Suspected Acute Myocarditis

Jakub Lagan et al. Diagnostics (Basel). .

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.

Keywords: magnetic resonance imaging; myocarditis; parametric mapping.

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Conflict of interest statement

Miller received research support from Amicus Therapeutics, Guerbet Laboratories Limited, Roche and Univar Solutions B.V. outside of the submitted work. Miller also served on an advisory board for Novartis, Boehringer Ingelheim and Lilly Alliance and AstraZeneca and serves as an advisor for HAYA therapeutics and PureTech Health. The other authors for this manuscript do not have any conflicts of interest to declare.

Figures

Figure 1
Figure 1
Derivation of the study cohort. CMR-cardiovascular magnetic resonance. * patients could have more than one diagnosis.
Figure 2
Figure 2
Multiparametric 1.5 T cardiac magnetic resonance in acute myocarditis. (A) Late gadolinium enhancement image showing focal enhancement in the inferolateral mid-wall (arrow). (B) T2 map. Inferolateral wall T2 elevated at 59 ms (arrow) compared to 47 ms in the anteroseptum. (C) Native T1 map. Inferolateral wall T1 elevated at 1286 ms (arrow) compared to 1009 ms in the anteroseptum. (D) Extracellular volume (ECV) map. Inferolateral wall ECV elevated at 53% (arrow) compared to 25% in the anteroseptum.
See this image and copyright information in PMC

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