Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up
Abstract
Background There is a major unmet need to identify high-risk patients in myocarditis. Although decreasing cardiac and inflammatory markers are commonly interpreted as resolving myocarditis, this assumption has not been confirmed as of today. We sought to evaluate whether routine laboratory parameters at diagnosis predict dynamic of late gadolinium enhancement (LGE) as persistent LGE has been shown to be a risk marker in myocarditis. Methods and results Myocarditis was diagnosed based on clinical presentation, high-sensitivity troponin T, and cardiac magnetic resonance imaging, after exclusion of obstructive coronary artery disease by angiography. Cardiac magnetic resonance imaging was repeated at 3 months. LGE extent was analyzed with the software GT Volume. Change in LGE >20% was considered significant. Investigated cardiac and inflammatory markers included high-sensitivity troponin T, creatine kinase, myoglobin, N-terminal B-type natriuretic peptide, C-reactive protein, and leukocyte count. Twenty-four patients were enrolled. Absolute levels of cardiac enzymes and inflammatory markers at baseline did not predict change in LGE at 3 months. Cardiac and inflammatory markers had normalized in 21 patients (88%). LGE significantly improved in 16 patients (67%); however, it persisted to a lesser degree in 17 of them (71%) and increased in a small percentage (21%) despite normalization of cardiac enzymes. Conclusions This is the first study reporting that cardiac enzymes and inflam…
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Myocarditis often occurs without necrosis, so the absence of elevated troponin does not rule out the presence of myocarditis, even severe myocarditis.
“However, myocarditis often occurs without necrosis so that the absence of elevated troponin does not rule out the presence of myocarditis, even severe myocarditis.”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [33]
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- Authors
- Berg, J., Kottwitz, J., Baltensperger, N., Kissel, C. K., Lovrinovic, M., Mehra, T., Scherff, F., Schmied, C., Templin, C., Lüscher, T. F., Heidecker, B., & Manka, R.
- Affiliations
- University Hospital Zurich (CH)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2017-11
- Volume
- 10
- Issue
- 11
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- OpenAlex
- W2769301739
- Cited by
- 89
- References
- 43
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 14 · 2023: 16 · 2022: 9 · 2021: 11 · 2020: 14 · 2019: 6 · 2018: 3 · 2017: 1
- FWCI
- 5.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- myocarditis, late gadolinium enhancement, cardiac enzymes, inflammatory markers, high-sensitivity troponin T, risk stratification, cardiac magnetic resonance imaging, disease activity, N-terminal B-type natriuretic peptide, C-reactive protein
- MeSH terms
- Adolescent, Adult, Aged, Contrast Media, Clinical Enzyme Tests, Enzymes, Female, Gadolinium, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocarditis, Myocardium, Predictive Value of Tests, Prognosis, Risk Factors, Time Factors, Reproducibility of Results, Biomarkers, Inflammation Mediators, Young Adult
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