Prognostic value of cardiovascular magnetic resonance in patients with strong suspicion for myocarditis
© Coelho-Filho et al; licensee BioMed Central Ltd. 2009
Published: 28 January 2009
While late gadolinium enhancement (LGE) imaging by Cardiovascular Magnetic Resonance (CMR) can detect evidence of myocarditis, the prognostic implication of this finding is still unknown.
The objective of this study is to assess the prognostic value of CMR in patients with suspected myocarditis.
After a median follow-up period of 1.3 years (range 6 months to 48 months), only 7 patients experienced adverse events including 1 death, 2 heart failure admissions, 3 cases of significant ventricular arrhythmias, and 1 recurrent episode of acute myocarditis. Mean left ventricular ejection fraction of the study cohort was 54 ± 14%. LGE was detected in 23 patients (30.2%) and was not significantly associated with MACE by Cox regression analysis. Presence of LGE in this study cohort was associated with an elevated left ventricular mass (65 ± 17 vs. 75 ± 30 g/m2, p = 0.01), regional wall motion abnormalities (OR = 22, p = 0.03), and with peak serum troponin (2.4 ± 6 vs. 12 ± 9, p = 0.05). The relationship between LGE and elevated left ventricular mass persisted after adjusting for comorbidities such as hypertension and diabetes. The LGE mass (mean 3.5 ± 6.7 g) was associated with CK levels (r = 0.02, p = 0.02), with CK-MB levels (r = 0.41, p = 0.008) and with troponin levels (r = 0.48, p = 0.002).
While a high proportion of patients were seen to have evidence of small myocardial involvement by LGE imaging consistent with acute myocarditis, overall patient prognosis of this clinical cohort with small LGE myocardial extent and preserved left ventricular ejection fraction is benign. CMR is helpful in the diagnosis of acute myocarditis and provides quantifiable parameters of the disease activity.
This article is published under license to BioMed Central Ltd.