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Cited by 435Viral Infections and Immunology ResearchCardiac Imaging and DiagnosticsCardiomyopathy and Myosin Studies

Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function

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Aquaro, Giovanni Donato, Perfetti, Matteo, Camastra, Giovanni, Monti, Lorenzo, Dellegrottaglie, Santo, Moro, Claudio, Pepe, Alessia, Todiere, Giancarlo +7 more·2017·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2017.08.044
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Abstract

Background The prognostic role of cardiac magnetic resonance (CMR) and late gadolinium enhancement (LGE) has not been clarified in acute myocarditis (AM) with preserved left ventricular (LV) ejection fraction (EF). Objectives This study sought to evaluate the role of CMR and LGE in the prognosis of AM with preserved LVEF. Methods This study analyzed data from ITAMY (ITalian multicenter study on Acute MYocarditis) and evaluated CMR results from 386 patients (299 male; mean age 35 ± 15 years) with AM and preserved LVEF. Clinical follow-up was performed for a median of 1,572 days. A clinical combined endpoint of cardiac death, appropriate implantable cardioverter-defibrillator firing, resuscitated cardiac arrest, and hospitalization for heart failure was used. Results Among the 374 patients with suitable images, LGE involved the subepicardial layer inferior and lateral wall in 154 patients (41%; IL group), the midwall layer of the anteroseptal wall in 135 patients (36%; AS [anteroseptal] group), and other segments in 59 patients (16%; other-LGE group), and it was absent in 26 patients (no-LGE group). The AS group had a greater extent of LGE and a higher LV end-diastolic volume index than other groups, but levels of inflammatory markers were lower than in the other groups. Kaplan-Meier curve analysis indicated that the AS group had a worse prognosis than the other groups (p < 0.0001). Finally, in multivariable analysis, AS LGE was the best independent CMR predictor of the combined endpoint (odds ratio: 2.73; 95% confidence interval: 1.2 to 5.9; p = 0.01). Conclusions In patients with AM and preserved LVEF, LGE in the midwall layer of the AS myocardial segment is associated with a worse prognosis than other patterns of presentation.

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  • Normal values of CRP, erythrocyte sedimentation rate, and cardiac troponins do not exclude myocarditis.

    “normal values do not exclude myocarditis.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [231]

    Table 1 (Patient Characteristics; page not supplied) reports abnormal ESR and/or CRP in 385 of 386 patients, so one patient had neither elevated marker. It also reports elevated troponin T in all 386 patients; the study therefore does not support the claim about normal troponin values. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • ECG in myocarditis can show either diffuse ST-segment elevations or ST-segment elevation in a coronary distribution.

    “can show either diffuse STsegment elevations or ST-segment elevation in a coronary distribution.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [231]

    The patient-characteristics passage reports ST-segment elevation in 73% of patients with acute myocarditis, supporting that ECG finding. It does not describe whether the elevation was diffuse or followed a coronary distribution; the Results passage describes the distribution of MRI enhancement, not ECG changes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The ECG is abnormal in the majority of patients with myocarditis.

    “The ECG is abnormal in the majority of patients with myocarditis”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [231]

    The patient-characteristics table reports ECG abnormalities in 371 patients (96%), supporting the claim for this study population. But the study was limited to acute myocarditis with preserved systolic function, and the Conclusions describe almost all patients as having an infarct-like presentation. It does not establish that ECGs are abnormal in the majority of patients with myocarditis generally. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Midwall and anteroseptal pattern late gadolinium enhancement on CMR confer a worse prognosis in myocarditis.

    “with midwall and anteroseptal pattern late gadolinium enhancement conferring a worse prognosis.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [231]

    The Abstract and Conclusions report that midwall anteroseptal late gadolinium enhancement was associated with a worse prognosis than other patterns. The study was limited to acute myocarditis with preserved left ventricular ejection fraction, so it does not establish the claim for myocarditis generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • CRP, erythrocyte sedimentation rate, and cardiac troponins are often elevated in myocarditis but are nonspecific.

    “Laboratory tests including CRP, erythrocyte sedimentation rate, and cardiac troponins are often elevated but are nonspecific”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [231]

    The patient-characteristics table (section labeled Conclusions; page unavailable) reports elevated troponin T in 100% of this study's patients and abnormal ESR and/or CRP in 99%. It does not establish that ESR and CRP were each often elevated, or state that these tests are nonspecific for myocarditis. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 24

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Authors
Aquaro, G. D., Perfetti, M., Camastra, G., Monti, L., Dellegrottaglie, S., Moro, C., Pepe, A., Todiere, G., Lanzillo, C., Scatteia, A., Di Roma, M., Pontone, G., Perazzolo Marra, M., Barison, A., & Di Bella, G.
Affiliations
  • Fondazione Toscana Gabriele Monasterio (IT)
  • IRCCS Humanitas Research Hospital (IT)
  • Icahn School of Medicine at Mount Sinai (US)
  • Policlinico Casilino (IT)
  • Federico II University Hospital (IT)
  • Centro Cardiologico Monzino (IT)
Corresponding author
Aquaro, Giovanni Donato
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-10
Volume
70
Issue
16
Pages
1977-1987
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2017.08.044
OpenAlex
W2762343916
Cited by
435
References
0
Citations by year
2026: 40 · 2025: 36 · 2024: 41 · 2023: 50 · 2022: 79 · 2021: 61 · 2020: 67 · 2019: 40 · 2018: 19 · 2017: 2
FWCI
27.09
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Keywords
acute myocarditis, preserved ejection fraction, late gadolinium enhancement, cardiac magnetic resonance, prognosis, inflammatory markers, composite endpoints, heart failure hospitalization, cardiovascular mortality, implantable cardioverter-defibrillator
MeSH terms
Acute Disease, Adult, Female, Follow-Up Studies, Gadolinium, Humans, Italy, Male, Middle Aged, Myocarditis, Radioisotopes, Ventricular Function, Left, Coronary Angiography, Magnetic Resonance Imaging, Cine

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