Abnormal T2 mapping cardiovascular magnetic resonance correlates with adverse clinical outcome in patients with suspected acute myocarditis

Abstract

BackgroundWhile most patients recover from suspected acute myocarditis (sAMC) some develop progressive disease with 5-year mortality up to 20%. Recently, parametric Cardiovascular Magnetic Resonance (CMR) approaches, quantifying native T1 and T2 relaxation time, have demonstrated the ability to increase diagnostic accuracy. However, prognostic implications of T2 values in this cohort are unknown. The purpose of the study was to investigate the prognostic relevance of elevated CMR T2 values in patients with sAMC.Methods and ResultsWe carried out a prospective study in 46 patients with sAMC defined by current ESC recommendations. A combined endpoint was defined by the occurrence of at least one major adverse cardiac event (MACE) and hospitalisation for heart failure. Event rate was 24% (n = 11) for 1-year-MACE and hospitalisation. A follow-up after 11 ± 7 months was performed in 98% of the patients. Global T2 values were significantly increased at acute stage of disease compared to controls and decreased over time. During acute disease, elevated global T2 time (odds ratio 6.3, p < 0.02) as well as myocardial fraction with T2 time >80 ms (odds ratio 4.9, p < 0.04) predicted occurrence of the combined endpoint. Patients with clinical recovery revealed significantly decreased T2 relaxation times at follow-up examinations; however, T2 values were still elevated compared to healthy controls.ConclusionAssessment of myocardial T2 relaxation times at initial presentation facilitates CMR-based risk stratification in patients with acute myocarditis. T2 Mapping may emerge as a new tool to monitor inflammatory myocardial injuries during the course of disease.

Quantitative myocardial tissue characterization by cardiac magnetic resonance in heart transplant patients with suspected cardiac rejection

“…An additional unique finding of our work is the association between an increase in T2 values and an increase in the risk of adverse cardiac outcomes. Similar associations have been demonstrated in a small cohort of patients with suspected acute myocarditis . It should be noted that some patients in our cohort may have been classified as having BNR instead of no rejection due to abnormal T2 values, since the clinical diagnosis of rejection may have been influenced by CMR findings.…”

Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy

“…Bohnen et al found that native myocardial T1 and T2 measurements provide excellent performance for monitoring the healing of myocarditis with a significant decline based on the stage of acute myocarditis [21]. Spieker et al also found T2 mapping to be a good tool for monitoring myocardial inflammation in patients with suspected acute myocarditis [22]. Alkhalil et al demonstrated that the anatomical area at risk may best be quantified by T1 mapping undertaken in the first week after reperfusion [23].…”

Oedema‐fibrosis in Duchenne Muscular Dystrophy: Role of cardiovascular magnetic resonance imaging

“…Unfortunately, the combination of T2W‐STIR and T2 mapping cannot differentiate the intracellular from extracellular oedema. However, the T2 mapping is currently considered as the best approach to detect and quantify myocardial oedema …”

“…However, the T2 mapping is currently considered as the best approach to detect and quantify myocardial oedema. 49…”