P982 Correlation between electrocardiographic and imaging data in patients with acute myocarditis: a single centre retrospective analysis

Abstract

Funding Acknowledgements None Background Acute myocarditis is a clinical and pathological condition defined as an inflammation of the myocardium. Its diagnosis is often challenging and requires multiple information derived from different diagnostic modalities. Purpose The aim of the study is to evaluate the correlation between electrocardiographic and imaging data in patients with acute myocarditis. Methods We made a retrospective analysis of 102 patients admitted to our Centre between January 2012 and April 2019 for suspected acute myocarditis. Diagnosis was confirmed with cardiac magnetic resonance (CMR) by identification of myocardial edema in T2-weighted images and/or typical subepicardial or midwall pattern of late gadolinium enhancement (LGE). Significant coronary artery disease was ruled out with coronary angiography. Electrocardiogram (ECG) was analysed on admission - in order to evaluate the presence of ST segment abnormalities, atrio-ventricular or bundle-branch block and heart rhythm disorders - and at the time of discharge. Every patient underwent echocardiography and CMR: from both these exams we reported the presence of regional wall motion abnormalities and left ventricular ejection fraction (LVEF). Results Mean age of our population was 39 ± 18 years; 92 people (90%) were males. At admission, 85 patients (83%) presented ECG abnormalities; the most frequent was ST-segment elevation (65 cases). Conduction or rhythm disorders were observed in 26 cases (25%). At the time of discharge, 41 out of 85 patients had complete regression of ECG changes. Mean value of LVEF measured with echocardiography was 56.4 ± 7.6%. In patients with normal ECG on admission it was 59.9 ± 3.1%, whereas in patients with abnormal ECG 55.7 ± 7.9% (p = 0.045). Considering CMR, mean LVEF in the population was 58.5 ± 8.6%, varying between 64.0 ± 8.9% in the group with normal ECG and 57.4 ± 10.1% in the group with ECG abnormalities (p = 0.02). Moreover, subjects with altered ECG on admission had a higher prevalence of wall motion abnormalities both in echocardiography (47/85 – 55% vs 3/17 – 18%, p < 0.01) and in CMR (45/85 – 53% vs 3/17 – 18%, p < 0.01). Patients with ECG normalization at discharge had a higher prevalence of ST-segment elevation (88 vs 66%, p = 0.02), while the group with persistent ECG alterations had a higher incidence of AV or bundle-branch block (23 vs 7%, p = 0.048). No statistical difference was noted between these two groups regarding echocardiographic or CMR values. Conclusion In our experience evaluation of ECG at admission in patients with suspected acute myocarditis identifies a subgroup of individuals with lower values of LVEF and a higher prevalence of wall motion abnormalities both in echocardiography and in CMR, while data derived by imaging techniques had no significant predictive value on ECG evolution at the time of discharge.