In patients with acute symptoms, mapping techniques provide a useful tool for confirming or rejecting the diagnosis of myocarditis and are superior to the LLC. However, only T2 mapping has acceptable diagnostic performance in patients with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis [MyoRacer]; NCT02177630).
The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management.
yocarditis is the leading cause of heart failure in individuals under 40 years of age (1). It frequently leads to dilated cardiomyopathy (2) and represents one of the most challenging diagnoses in clinical cardiology. Growing clinical evidence exists that myocarditis is a multifaceted disease, where different subtypes can be differentiated based on the predominant clinical presentation (3). Consequently, the diagnostic approach for myocarditis manifesting with symptoms of heart failure (heart failure-like myocarditis) should be different from myocarditis with acute infarctlike presentation (3-6). Establishing the timely and correct diagnosis, especially in individuals with heart failure-like myocarditis, is of importance because these individuals might benefit from a tailored therapeutic strategy. However, the primary tools for noninvasive diagnosis of myocarditis, including cardiac MRI and diagnostic requirements as defined by the Lake Louise criteria, have been shown to exhibit a very limited diagnostic accuracy in heart failurelike and chronic myocarditis (3-7). Recently, T1 and T2 mapping techniques have been introduced as quantitative approaches for a more reliable
These findings prove the theoretical concept of ECV as an estimate for diffuse myocardial fibrosis, but only in the absence of significant myocardial inflammation. Assuming that various degrees of myocardial inflammation and fibrosis coexist in such a scenario, the measured ECV will reflect a sum of these different pathologies but will not inform solely on the extent of diffuse fibrosis.
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