Comprehensive Cardiac Magnetic Resonance for Short‐Term Follow‐Up in Acute Myocarditis

Abstract

BackgroundCardiac magnetic resonance (CMR) can detect inflammatory myocardial alterations in patients suspected of having acute myocarditis. There is limited information regarding the degree of normalization of CMR parameters during the course of the disease and the time window during which quantitative CMR should be most reasonably implemented for diagnostic work‐up.Methods and ResultsTwenty‐four patients with suspected acute myocarditis and 45 control subjects underwent CMR. Initial CMR was performed 2.6±1.9 days after admission. Myocarditis patients underwent CMR follow‐up after 2.4±0.6, 5.5±1.3, and 16.2±9.9 weeks. The CMR protocol included assessment of standard Lake Louise criteria, T1 relaxation times, extracellular volume fraction, and T2 relaxation times. Group differences between myocarditis patients and control subjects were highest in the acute stage of the disease (P<0.001 for all parameters). There was a significant and consistent decrease in all inflammatory CMR parameters over the course of the disease (P<0.01 for all parameters). Myocardial T1 and T2 relaxation times—indicative of myocardial edema—were the only single parameters showing significant differences between myocarditis patients and control subjects on 5.5±1.3‐week follow‐up (T1: 986.5±44.4 ms versus 965.1±28.1 ms, P=0.022; T2: 55.5±3.2 ms versus 52.6±2.6 ms; P=0.001).ConclusionsIn patients with acute myocarditis, CMR markers of myocardial inflammation demonstrated a rapid and continuous decrease over several follow‐up examinations. CMR diagnosis of myocarditis should therefore be attempted at an early stage of the disease. Myocardial T1 and T2 relaxation times were the only parameters of active inflammation/edema that could discriminate between myocarditis patients and control subjects even at a convalescent stage of the disease.

Native T1 reference values for nonischemic cardiomyopathies and populations with increased cardiovascular risk: A systematic review and meta‐analysis

“…1. A total of ten studies were included for the HCM group, 17,29-37 nine for DCM, 11,30,33,35,[38][39][40][41][42] twelve in MC, 30,[43][44][45][46][47][48][49][50][51][52][53] five in iron overload, 54-58 six in amyloidosis, 32,[59][60][61][62][63] two in Fabry disease, 64,65 ten in HT, 13,17,34,37,[66][67][68][69][70][71] four in DM, [72][73][74][75] and one in obesity 74 ( Table 1). The field strength is known to influence the T 1 values significantly 65 ; therefore, results from studies performed on a 1.5T or 3T are shown separately, but used as covariant in the meta-regression analysis.…”

“…The T 1 value for the whole SAX showed no significant difference between DCM patients and controls ( P = 0.05), while the T 1 values in the septal ROI were significantly increased for DCM patients ( P < 0.05). In addition to this, the T 1 values of studies that used the segmental approach also suffered from averaging . Furthermore, some studies used the 4‐chamber plane for T 1 mapping, which can lead to errors due to through‐plane respiratory motion.…”

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

“…Barone-Rochette et al (2014) also applied a simplified visual quantitative score of LGE to identify the outcomes of AM patients, with LGE identified as an independent predictor of all cause and cardiac mortality in these AM patients. In patients with AM, significantly continuous decrease of LGE volume percentage had been observed over several follow-up CMR examinations, which demonstrated a rapid and continuous decrease of myocardial inflammation (Luetkens et al, 2016). The myocardial inflammation was easier to subside in a small area of LGE, which indicated better outcomes.…”

The Prognostic Role of T1 Mapping Sequences: Can T1 Mapping Parameters Have a Role in Risk Stratification?

“…Regarding this question, Luetkens et al [52] reported that there was a significant and consistent decrease in all inflammatory CMR parameters over the course of the disease (p<0.01 for all parameters). Myocardial T1 and T2 relaxation times-indicative of myocardial edema-were the only single parameters showing significant differences between myocarditis patients and control subjects at the 5.5±1.3-week follow-up (native T1: 986.5±44.4 vs. 965.1± www.e-cvia.org 201 [53] reported that although both T2 and T1 mapping reliably detected acute myocarditis, only T2 mapping discriminated between acute and healed stages, underlining the incremental value of T2 mapping.…”