A retrospective study: cardiac MRI of fulminant myocarditis in children—can we evaluate the short-term outcomes?

Abstract

BackgroundFulminant myocarditis (FM) is an inflammatory disease of the myocardium that results in ventricular systolic dysfunction and causes acute-onset heart failure. Cardiac magnetic resonance (CMR) has become the primary noninvasive tool for the diagnosis and evaluation of myocarditis. The aim of our study was to assess the CMR findings at different course of FM and the short-term outcomes of fulminant myocarditis (FM) in children.MethodsEight FM children with CMR examinations were included in our study. Initial baseline CMR was performed 10 days (range, 7–20 days) after onset of FM and follow-up CMR after 55 days (range, 33–75 days). Cardiac morphology and function and myocardial tissue characterization at baseline and follow-up CMR were compared using paired T-test and Mann–Whitney U test. The clinical data and initial CMR findings were also compared to predict short-term outcomes.ResultsThe median age of eight FM children was 8.5 years old (range, 3–14). The initial CMR findings were most common with early gadolinium enhancement (EGE, 100%), followed by signal increasing on T2WI and late gadolinium enhancement (LGE, 87.5%), increased septal thickness (75.0%) and increased left ventricle ejection fraction (LVEF, 50.0%). Only three LGE (37.5%), one signal increasing on T2WI (12.5%) and one increased LVEF (12.5%) were found at follow-up. Statistically significant differences were found between initial and follow-up CMR abnormalities in the septal thickness, left ventricular end-diastolic diameter (LVEDD), end-systolic volume (ESV), LVEF, left ventricular mass, T2 ratio and LGE area (P = 0.011, P = 0.042, P = 0.016, P = 0.001, P = 0.003, P = 0.011, P = 0.020). The children with full recovery performed higher incidence of III° atrioventricular block (AVB, five cases VS 0 case) and smaller LGE area (104.0 ± 14.5 mm2 VS 138.0 ± 25.2 mm2) at baseline CMR.DiscussionThe CMR findings of FM in children were characteristic and useful for early diagnosis. Full recovery of clinical manifestations, immunological features and CMR findings could be found in most FM children. The presence of III° AVB and smaller LGE area at baseline CMR might indicate better short-term outcomes.

The Possible Role of IVIG in the Treatment of Atrial Fibrillation Accompanied by Fulminant Myocarditis in a 12-Year-Old Pediatric Patient

“…Cardiac troponin, CKMB, and CRP levels are all indicators of a possible myocardial injury. Currently, MRI is considered the gold standard due to its noninvasive utility in diagnosing and evaluating myocarditis in children [6]. e Lake Louise criteria were formulated in 2009. e requirements describe the findings on contrastenhanced MRI, increasing the sensitivity and specificity for the diagnosis of myocarditis.…”

Early characteristics of fulminant myocarditis vs non-fulminant myocarditis

“…Currently, cardiac magnetic resonance (CMR) has become the primary noninvasive tool for the diagnosis and evaluation of myocarditis. [35] It provides good accuracy in measurement of LVEF, LVEDd, LVPWd, and IVSd. [36] We should focus on differences between FM and NFM using CMR in further studies.…”

The Clinical Features of Children With Acute Fulminant Myocarditis and the Diagnostic and Follow-Up Value of Cardiovascular Magnetic Resonance

“…We found that the sensitivity of CMR was different between the acute phase and the recovery phase: T2WI sensitivity was 75 and 50%, respectively, in the acute phase and the recovery phase, and LGE sensitivity was 75 and 62.5%, respectively, in the acute phase and the recovery phase, suggesting that myocardial edema began to resolve 14 days after onset while LGE was relatively delayed. In 2016, Wang et al performed an early CMR examination and short-term follow-up of 8 children with AFM (22). It was found that CMR has certain value for the early diagnosis and short-term follow-up of children with AFM.…”