Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study

Abstract

BackgroundCardiovascular magnetic resonance (CMR) is increasingly used to diagnose myocarditis in adults but its use in children is not well-established. We sought to describe the presentation, CMR protocol and findings, and outcomes in a multicenter cohort of children with myocarditis.MethodsThirteen hospitals retrospectively identified patients meeting the following inclusion criteria: 1) diagnosis of myocarditis by the managing physicians, 2) age <21 years, 3) CMR examination within 30 days of presentation, and 4) no congenital heart disease. Clinical data and test results, including CMR findings, were abstracted from the medical record.ResultsFor the 143 patients meeting inclusion criteria, the median age was 16.0 years (range, 0.1-20.3) and 139 (97 %) were hospitalized at the time of CMR. The median time from presentation to CMR was 2 days (0-28). The median left ventricular ejection fraction at CMR was 56 % (10-74), with 29 (20 %) below 45 %. The median right ventricular ejection fraction was 54 % (15-72), with 11 (8 %) below 40 %. There was significant variability among centers in the types of tissue characterization techniques employed (p < 0.001). Overall, late gadolinium enhancement (LGE) was used in 100 % of studies, followed by T2-weighted imaging (T2W) in 69 %, first-pass contrast perfusion (FPP) in 48 %, and early gadolinium enhancement (EGE) in 28 %. Abnormalities were most common with LGE (81 %), followed by T2W (74 %), EGE (55 %), and FPP (8 %). The CMR study was interpreted as positive for myocarditis in 117 patients (82 %), negative in 18 (13 %), and equivocal in 7 (5 %), yielding a sensitivity of 82 %. At a median follow-up of 7.1 months (0-87), all patients were alive and 5 had undergone cardiac transplantation. CMR parameters at presentation associated with persistent left ventricular dysfunction were larger left ventricular end-diastolic volume and lower left and right ventricular ejection fraction but not abnormal LGE.ConclusionsDespite significant practice variation in imaging protocol among centers, CMR had a high sensitivity for the diagnosis of myocarditis in pediatric patients. Abnormalities were most often seen with LGE followed by T2W, EGE, and FPP. These findings should be useful in designing future prospective studies.

Junctional ectopic tachycardia secondary to myocarditis associated with sudden cardiac arrest

“…In fact, the occurrence of JET is a good predictor for spontaneous recovery of AV conduction following the onset of postoperative CHB 10 . Unique to our case in support of this theory was evidence of both early and delayed gadolinium enhancement on cardiac MRI, 11 seen scattered throughout the ventricular septum, including the basal septum. With resolution of the JET and normalization of left ventricular function, antiarrhythmic medications were successfully discontinued.…”

A retrospective study: cardiac MRI of fulminant myocarditis in children—can we evaluate the short-term outcomes?

“…High specificity of LGE for the detection of myocardial injury in myocarditis had been demonstrated in several studies (Cooper et al, 2007; Abdel-Aty et al, 2005; Mahrholdt et al, 2004). In our study, patchy mid-wall or subepicardial LGE in the LV walls were found in seven FM children (87.5%), which were similar to those in AM children (Banka et al, 2015; Sachdeva et al, 2015). Similar mid-wall LGE were also found in a 33-year-old female FM patient (Ryu et al, 2013).…”

TNFα Modulates Cardiac Conduction by Altering Electrical Coupling between Myocytes

“…Mechanically, myocardial inflammation can cause cardiac dysfunction and reduced ejection fraction (Lurz et al, 2012; Banka et al, 2015). Myocardial inflammation can also alter electrical impulse propagation by modulating gap junctional coupling (GJC) (Zhu et al, 2000; Xu H. F. et al, 2012), ionic currents (Tang et al, 2007; De Jesus et al, 2015), and tissue hydration state (Logstrup et al, 2015).…”