Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 2;15(1):486-501.
doi: 10.21037/qims-24-1422. Epub 2024 Dec 30.

Multiparametric cardiovascular magnetic resonance in patients with myocarditis with consecutive follow-up and a comparison between non-COVID-19 and COVID-19-associated myocarditis

Xiaorong Chen  1 , Yi Hu  1 , Jiangfeng Pan  1 , Limei Ye  1 , Yonghao Pan  1 , Qing Liu  1
Affiliations

Multiparametric cardiovascular magnetic resonance in patients with myocarditis with consecutive follow-up and a comparison between non-COVID-19 and COVID-19-associated myocarditis

Xiaorong Chen et al. Quant Imaging Med Surg. .

Abstract

Background: The pattern of myocardial injury and dysfunction development during follow-up is unclear in patients with myocarditis. This study aims to explore the developmental pattern of myocardial injury and cardiac dysfunction during the follow-up of myocarditis by cardiac magnetic resonance (CMR) and differences in short-term follow-up CMR performance between patients with coronavirus disease 2019 (COVID-19)-associated myocarditis (CAM) and non-COVID-19-associated myocarditis (NCAM).

Methods: Data of patients with clinically diagnosed myocarditis who underwent follow-up CMR were retrospectively collected. Patients were divided into the NCAM follow-up and CAM follow-up groups. A portion of patients with normal CMR and volunteers was categorized as control. Qualitative and quantitative assessments of CMR images were used to analyze cardiac structure, function and myocardial damage; compare the differences between the groups; and reveal the developmental pattern in the consecutive follow-up for patients with myocarditis.

Results: This study included 75 patients with NCAM, 25 patients with CAM and 75 cases as control group. Compared with the control group, there was an increase in left ventricular volume, right ventricular volume, extracellular volume in the NCAM follow-up (the last time) group, left ventricular volume, right ventricular ejection fraction, global radial strain (GRS), global circumferential strain, global longitudinal strain (GLS), post-contrast T1 value were decreased. The area under the curve of the GLS was the best (0.836) in discriminating between the two groups, with 78.7% sensitivity and 84.0% specificity. The discriminatory efficacy of the combined right ventricular ejection fraction, GRS, and GLS multiparameter showed the best area under the curve at 0.847, with 80.0% sensitivity and 85.3% specificity. Between the CMR parameter of short- (3 months), medium-, and long-term follow-up (>6 months) for patients with NCAM, a decrease in native T1 (1,256.50±18.63 vs. 1,248.30±17.87 ms, P=0.007) and T2 (49.00±1.34 vs. 47.50±0.97 ms, P=0.015) values was noted in the short-term follow-up group. The short-term follow-up group showed increased ventricular volume, decreased ejection fraction, and impaired myocardial strain in CAM and NCAM compared with the control group. The CAM short-term follow-up group showed an increased T2 value (52.56±3.64 vs. 49.08±3.84 ms, P=0.008) compared with the NCAM short-term follow-up group, and the T2 value was identified with an area under the curve of 0.772, 76% sensitivity, and 83% specificity for the discrimination.

Conclusions: This study revealed that myocarditis led to myocardial damage, cardiac remodeling, and dysfunction during follow-up. An improvement in myocardial edema in the medium- and long-term follow-up groups was observed. In the short-term follow-up, CAM showed more severe myocardial edema. These findings may contribute to the clinical assessment and management of post-myocarditis status.

Keywords: Myocarditis; coronavirus disease 2019 (COVID-19); follow-up; magnetic resonance imaging (MRI).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-1422/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cardiac magnetic resonance characteristics of patients with non-COVID-19 associated myocarditis at three different timepoints: baseline (A,D), first follow-up (3 months) (B,E), and second follow-up (>6 months) (C,F), and patients with COVID-19 associated myocarditis (follow-up in 3 months) (G-I). White arrows indicate myocardial edema (A-C,G), hyperemia (H), necrosis and fibrosis (D-F,I). Arrow head indicates pericardial effusion (H). COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
Comparison of cardiac magnetic resonance strain parameters between the control and non-COVID-19 associated myocarditis groups at the last follow-up examination. COVID-19, coronavirus disease 2019.
Figure 3
Figure 3
Receiver operating characteristic curves of single GLS parameter and combined RVEF, GRS, and GLS multiparameter for the control and NCAM groups. AUC, area under the curve; GLS, global longitudinal strain; RVEF, right ventricular ejection fraction; GRS, global radial strain; NCAM, non-COVID-19 associated myocarditis; COVID-19, coronavirus disease 2019.
Figure 4
Figure 4
Comparison of native T1 and T2 values for patients with non-COVID-19 associated myocarditis at three different timepoints: baseline, first follow-up (in 3 months), and second follow-up (>6 months). COVID-19, coronavirus disease 2019.
Figure 5
Figure 5
Receiver operating characteristic performance of cardiac magnetic resonance parameters between the control and non-COVID-19 associated myocarditis groups at the last follow-up. COVID-19, coronavirus disease 2019; AUC, area under the curve.
See this image and copyright information in PMC

References

    1. Mavrogeni S, Spargias C, Bratis C, Kolovou G, Markussis V, Papadopoulou E, Constadoulakis P, Papadimitropoulos M, Douskou M, Pavlides G, Cokkinos D. Myocarditis as a precipitating factor for heart failure: evaluation and 1-year follow-up using cardiovascular magnetic resonance and endomyocardial biopsy. Eur J Heart Fail 2011;13:830-7. 10.1093/eurjhf/hfr052 - DOI - PubMed
    1. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. 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;34:2636-48, 2648a-2648d. - PubMed
    1. Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update: Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020;22:19. 10.1186/s12968-020-00610-6 - DOI - PMC - PubMed
    1. Blissett S, Chocron Y, Kovacina B, Afilalo J. Diagnostic and prognostic value of cardiac magnetic resonance in acute myocarditis: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2019;35:2221-9. 10.1007/s10554-019-01674-x - DOI - PubMed
    1. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, White JA, Abdel-Aty H, Gutberlet M, Prasad S, Aletras A, Laissy JP, Paterson I, Filipchuk NG, Kumar A, Pauschinger M, Liu P, International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis . Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol 2009;53:1475-87. 10.1016/j.jacc.2009.02.007 - DOI - PMC - PubMed

LinkOut - more resources