Diagnostic Accuracy of Cardiovascular Magnetic Resonance in Acute Myocarditis

Kotanidis, Christos; Bazmpani, Maria-Anna; Haidich, Anna‐Bettina; Karvounis, Charalambos; Antoniades, Charalambos; Karamitsos, Theodoros D.

doi:10.1016/j.jcmg.2017.12.008

Cited by 149 publications

(110 citation statements)

References 31 publications

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“…Additionally, we do not distinguish patients with dilated cardiomyopathy, although myocarditis is a known underlying cause of dilated cardiomyopathy. Even using modern diagnostic techniques, accurate diagnosis of myocarditis is limited [35]. It is important to note that our study did not investigate the diagnostic accuracy of these techniques, rather compared the association of ECG and CMR findings in a real-world setting of patients with a clinical referral of suspected myocarditis.…”

Section: Limitationsmentioning

confidence: 99%

Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging

et al. 2020

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Background Risk stratification of myocarditis is challenging due to variable clinical presentations. Cardiovascular magnetic resonance (CMR) is the primary non-invasive imaging modality to investigate myocarditis while electrocardiograms (ECG) are routinely included in the clinical workup. The association of ECG parameters with CMR tissue characterisation and their prognostic value were investigated in patients with clinically suspected myocarditis. Methods and results Consecutive patients with suspected myocarditis who underwent CMR and ECG were analysed. Major adverse cardiovascular event (MACE) included all-cause death, hospitalisation for heart failure, heart transplantation, documented sustained ventricular arrhythmia, or recurrent myocarditis. A total of 587 patients were followed for a median of 3.9 years. A wide QRS-T angle, low voltage and fragmented QRS were significantly associated with late gadolinium enhancement. Further, a wide QRS-T angle, low voltage and prolonged QTc duration were associated with MACE in the univariable analysis. In a multivariable model, late gadolinium enhancement (HR: 1.90, 95%CI: 1.17-3.10; p = 0.010) and the ECG parameters of a low QRS voltage (HR: 1.86, 95%CI: 1.01-3.42; p = 0.046) and QRS-Tangle (HR: 1.01, 95%CI: 1.00-1.01; p = 0.029) remained independently associated with outcome. The cumulative incidence of MACE was incrementally higher when findings of both CMR and ECG were abnormal (p<0.001).

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Section: Limitationsmentioning

confidence: 99%

Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging

et al. 2020

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“…The metaanalysis shows that LLC have been firmly established in clinical practice and that the use of native of T1 mapping can further enhance CMR accuracy in diagnosing myocarditis. These findings are supported by another meta-analysis including 22 studies by Kotanidis et al (50), which similarly concludes that native T1 mapping has a significantly higher diagnostic accuracy compared to all other index tests: native T1 mapping showed an area under the curve (AUC) of 0.95 compared to T2 mapping with an AUC of 0.88 and LLC of 0.81 and will therefore likely be implemented in the upcoming updated Lake Louise Criteria. Additionally, the authors showed that T2 mapping was superior to T2-weighted and EGE imaging, suggesting that both EGE and T2-weighted imaging could be replaced by T1 -and T2 mapping respectively (50).…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 59%

Myocarditis in Athletes Is a Challenge

Eichhorn

Bière

Schnell³

et al. 2020

JACC: Cardiovascular Imaging

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Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold-standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging (CMR), and in certain cases endomyocardial biopsy (EMB) helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert's opinions, current recommendations generally advise abstinence from competitive sports ranging from 3 to 6 months. However, the dilemma poses that (un-) necessary prolonged disqualification of athletes in order to avoid adverse cardiac events, can cause considerable disruption to training schedules and tournament preparation, and leading to a decline in performance and ability to compete. Therefore, better risk stratification tools are needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of CMR imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to risk stratify athletes with suspected myocarditis more systematically, and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, more evidence, based on large multicenter registries including CMR and EMB, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive-and invasive tissue characterization methods.

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“…In particular, T1 and T2-weighted images evaluate hyperemia and capillary leakage, necrosis and fibrosis, and intracellular and interstitial edema -3 markers of tissue injury [5]. A recent systematic review and meta-analysis showed that native T1 image can improve diagnostic accuracy of cardiac magnetic resonance in acute myocarditis [6]. Endomyocardial biopsy (EMB) confirms the diagnosis of myocarditis and recognizes the etiology and the type of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Acute Epstein-Barr related myocarditis: An unusual but life-threatening disease in an immunocompetent patient

Watanabe

Panetta

Piccirillo

et al. 2020

Journal of Cardiology Cases

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Diagnostic Accuracy of Cardiovascular Magnetic Resonance in Acute Myocarditis

Abstract: Novel CMR mapping techniques provide high diagnostic accuracies for the diagnosis of acute myocarditis and constitute promising successors of the classic elements of the LLC for routine diagnostic protocols.

Cited by 149 publications

References 31 publications

Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging

Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging

Myocarditis in Athletes Is a Challenge

Acute Epstein-Barr related myocarditis: An unusual but life-threatening disease in an immunocompetent patient

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