Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function

Aquaro, Giovanni Donato; Perfetti, Matteo; Camastra, Giovanni; Monti, Lorenzo; Dellegrottaglie, Santo; Moro, Claudio; Pepe, Alessia; Todiere, Giancarlo; Lanzillo, Chiara; Scatteia, Alessandra; Roma, Mauro Di; Pontone, Gianluca; Marra, Martina Perazzolo; Barison, Andrea; Bella, Gianluca Di

doi:10.1016/j.jacc.2017.08.044

Cited by 357 publications

(257 citation statements)

References 22 publications

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“…The number of enrolled patients and follow‐up period were quite limited. In a recent multicenter study in which were involved 374 patients with a median follow‐up of 1572 days, only 8 (2.1%) patients had major cardiac events (sudden cardiac deaths; resuscitated cardiac arrests, appropriate ICD firings) …”

Section: Discussionmentioning

confidence: 99%

“…First of all, our study population was entirely composed of male Caucasian patients, and we cannot extend our findings to women or patients of different ethnicities. The number of enrolled patients and follow-up period were quite limited.In a recent multicenter study in which were involved 374 patients with a median follow-up of 1572 days, only 8 (2.1%) patients had major cardiac events (sudden cardiac deaths; resuscitated cardiac arrests, appropriate ICD firings) 36. …”

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confidence: 99%

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Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction

et al. 2018

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Background The aim of present study was to assess left ventricular (LV) myocardial deformation and changes over time in patients with acute myocarditis (AM) with preserved ejection fraction detected by late gadolinium enhancement (LGE) magnetic resonance imaging. Methods Thirty‐five male patients with AM diagnoses and preserved systolic function based on cardiac magnetic resonance imaging (MRI) were prospectively enrolled. On admission, echocardiography with measurements of global and segmental longitudinal (LS) strains was performed both at the endocardial (ENDO) and epicardial (EPI) levels. Findings were compared to 25 control subjects. Twenty‐six patients were also monitored over a 22‐month follow‐up (FU group). Results On admission, global ENDO‐LS was poorer in magnitude in AM (−19.2 ± 3.1) than in controls (−24.0 ± 1.05) (P < 0.0001), whereas EPI‐LS was not different (−20.6 ± 3.4 vs −19.7 ± 6 P = NS). A functional increase in magnitude in both ENDO‐LS (−20.8 ± 5.4, P = NS) and EPI‐LS (−22.6 ± 4.6, P = 0.02) was found in FU vs AM patients. Conclusions The present study demonstrates a steady ENDO‐LS impairment in infarct‐like AM during a 2‐year follow‐up period, despite a preserved LV ejection fraction.

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Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction

et al. 2018

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“…More sophisticated tools for aetiological workup include CMR which is most accurate for determining LA and LV volumes and mass, 270 detects scar and myocardial ischaemia due to epicardial coronary disease or microvascular dysfunction, 65 and stress perfusion imaging to reveal diffuse subendocardial defects. Regional and diffuse myocardial oedema (T2‐imaging) and infiltration or fibrosis are quantified using late gadolinium enhancement [LGE; for extracellular volume fraction (ECV)] or T1‐mapping 137 , 267 , 271–274 (online supplementary Appendix ). Right or left ventricular myocardial biopsy, (99m) Tc‐DPD scintigraphy to identify cardiac amyloidosis, positron emission tomography (PET)‐CT, as well as specific genetic and laboratory tests ( Figure B ) should be considered in selected cases where a specific aetiology is suspected.…”

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confidence: 99%

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

418

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Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre‐test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non‐cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), LV filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

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“…11 There is also a role for cardiac MRI with late gadolinium enhancement (LGE) after acute myocarditis, with the presence of LGE being a strong independent predictor of adverse clinical outcomes. 12 In summary, this case highlights the importance of rapid access to VA-ECMO support for patients with acute deterioration into cardiogenic shock, as occurred in this young woman with fulminant lymphocytic myocarditis. Although the risk of mortality remains high despite timely initiation of appropriate mechanical support, survival is achievable even in cases with profound conduction disease and myocardial standstill.…”

Section: Discussionmentioning

confidence: 71%

A case of fulminant perimyocarditis leading to extensive ECMO treatment and spinal injury resulting in paraplegia

Magnusson

Levin

Mattsson

et al. 2018

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Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function

Abstract: In patients with AM and preserved LVEF, LGE in the midwall layer of the AS myocardial segment is associated with a worse prognosis than other patterns of presentation.

Cited by 357 publications

References 22 publications

Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction

Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

A case of fulminant perimyocarditis leading to extensive ECMO treatment and spinal injury resulting in paraplegia

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