Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: clinical and prognostic implications

Lazzari, Manuel De; Zorzi, Alessandro; Baritussio, Anna; Siciliano, Mariachiara; Migliore, Federico; Susana, Angela; Giorgi, Benedetta; Lacognata, Carmelo; Iliceto, Sabino; Marra, Martina Perazzolo; Corrado, Domenico

doi:10.1016/j.jelectrocard.2016.04.002

Cited by 27 publications

(27 citation statements)

References 22 publications

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“…It is suggested that noninvasive cardiac magnetic resonance imaging might provide an alternative method for diagnosis and its use is recommended as early as possible at onset of the disease when its validity is the highest. Recent research on patients in whom acute myocarditis was clinically suspected for the first time confirmed association of left ventricle transmural myocardial oedema evidenced by contrast-enhanced cardiac magnetic resonance and T wave inversion [17]. The latter has been registered in our patient's ECG ( Figure 1) and also associated with myocardial oedema in the presence of minimal pericardial effusion on echocardiography.…”

Section: Discussionsupporting

confidence: 75%

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

et al. 2016

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Section: Discussionsupporting

confidence: 75%

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

et al. 2016

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“…Recently, an association between T‐wave abnormalities and myocardial edema evaluated with T2W imaging has been reported in patients with conditions other than ACS, namely myocarditis and takotsubo cardiomyopathy 22, 23. The pathophysiological links between myocardial edema and T‐wave abnormality remain to be fully elucidated, although we could speculate that edematous myocardium is marked by dispersion of repolarization potentials to produce this specific ECG finding.…”

Section: Discussionmentioning

confidence: 92%

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

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BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

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“…Infarct‐like symptoms portend a worse prognosis primarily due to recurrent myocarditis . De Lazzari et al showed that dynamic T‐wave inversions (TWI) likely reflect myocardial edema, although these ECG changes are neither sensitive nor specific for myocarditis …”

Section: Non‐mri Diagnostic Modalitiesmentioning

confidence: 99%

“…28 De Lazzari et al 29 showed that dynamic T-wave inversions (TWI) likely reflect myocardial edema, although these ECG changes are neither sensitive nor specific for myocarditis. 29 Invasive and noninvasive modalities can be employed to assess CAD. Echocardiography may show global or segmental wall motion abnormalities compatible with possible infarct.…”

Section: Non-mri Diagnostic Modalitiesmentioning

confidence: 99%

State of the art: Evaluation and prognostication of myocarditis using cardiac MRI

Gannon

Schaub

Grines³

et al. 2019

Magnetic Resonance Imaging

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Myocarditis encompasses both primary and secondary processes causing inflammation of the myocardium. Viral infections are a common secondary cause of myocarditis with important clinical relevance. Viral myocarditis has a varied clinical presentation, potentially resulting in significant morbidity and mortality. Acutely, systolic dysfunction and sudden cardiac death may ensue; chronically, myocarditis may result in a dilated cardiomyopathy requiring heart transplantation. Myocarditis is thought to be one of the most common causes of myocardial infarction with nonobstructive coronary arteries (MINOCA), with important consequences for cardiovascular outcomes. Patients with myocarditis are currently underdiagnosed. Cardiac MRI has evolved as the noninvasive test of choice, with cardiac MRI‐specific diagnostic requirements defined in the Lake Louise Criteria (LLC). Detecting the presence of tissue edema, hyperemia, and necrosis in both acute and chronic stages form the foundation of the LLC. Cardiac MR for chronic myocarditis (greater than 8 weeks from symptom onset) has decreased sensitivity for diagnosis. Emerging sequences such as T1 and T2 parametric maps provide tissue characterization regarding inflammation without reliance on reference tissue, overcoming limitations of the LLC. Beyond diagnostic criteria, these imaging techniques have proven useful in further characterizing the diseased tissue, prognostication, and clinical decision‐making. This review describes the utility and evolving use of cardiac MRI in clinical practice. Level of Evidence: 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2018;47:1061–1071.

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Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: clinical and prognostic implications

Cited by 27 publications

References 22 publications

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

Synchronous advanced pulmonary tuberculosis and acute virus myocarditis mimicked wegener granulomatosis in a 26-year-old man: A case report

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

State of the art: Evaluation and prognostication of myocarditis using cardiac MRI

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