Subendocardial Involvement as an Underrecognized Cardiac MRI                     Phenotype in Myocarditis

Li, Jing-Hui; Xu, Xi-Qi; Zhu, Yixuan; Cheng, Chun‐Yan; Lü, Ming-De; Wang, Hongyue; Jing, Zhi-Cheng; Zhao, Shihua

doi:10.1148/radiol.2021211276

Cited by 11 publications

(13 citation statements)

References 30 publications

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“…Until two recent original reports from China, 14 , 15 CMR findings in GCM had been described only in solitary case reports and mostly in passing with results of other diagnostic examinations. 16–24 The studies by Yang et al .…”

Section: Discussionmentioning

confidence: 99%

“… 14 and Li et al . 15 were based on two overlapping case series from the same Chinese centres and apparently involved only seven individual cases of GCM. The authors focused on the myocardial distribution of LGE and showed that all patients had LGE in both ventricles, multilayer LGE was frequent, and the most involved areas were the RV side of the septum, subepicardial LV anterior wall, and subendocardial RV wall.…”

Section: Discussionmentioning

confidence: 99%

“… 12 There exist many CMR studies on CS, reviewed of late thoroughly by Smedema et al . 13 whereas CMR findings in GCM have been described only in two small case series 14 , 15 and in solitary case reports. 16–24 Myocardial late gadolinium enhancement (LGE) appears ubiquitous in both conditions and preferentially subepicardial in CS 13 and subendocardial in GCM.…”

Section: Introductionmentioning

confidence: 98%

“… 16–24 Myocardial late gadolinium enhancement (LGE) appears ubiquitous in both conditions and preferentially subepicardial in CS 13 and subendocardial in GCM. 14 , 15 , 25 Whether CMR can help distinguish between these conditions is unknown, however, as no study has systematically compared GCM with CS. The present work was designed to fill that gap.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac magnetic resonance in giant cell myocarditis: a matched comparison with cardiac sarcoidosis

Pöyhönen

Nordenswan

Lehtonen

et al. 2023

European Heart Journal - Cardiovascular Imaging

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Aims Giant cell myocarditis (GCM) is an inflammatory cardiomyopathy akin to cardiac sarcoidosis (CS). We decided to study the findings of GCM on cardiac magnetic resonance (CMR) imaging and to compare GCM with CS. Methods and results CMR studies of 18 GCM patients were analyzed and compared with 18 CS controls matched for age, sex, left ventricular (LV) ejection fraction and presenting cardiac manifestations. The analysts were blinded to clinical data. On admission, the duration of symptoms (median) was 0.2 months in GCM vs. 2.4 months in CS (P = 0.002), cardiac troponin T was elevated (>50 ng/L) in 16/17 patients with GCM and in 2/16 with CS (P < 0.001), their respective median plasma B-type natriuretic propeptides measuring 4488 ng/L and 1223 ng/L (P = 0.011). On CMR imaging, LV diastolic volume was smaller in GCM (177 ± 32 mL vs. 211 ± 58 mL, P = 0.014) without other volumetric or wall thickness measurements differing between the groups. Every GCM patient had multifocal late gadolinium enhancement (LGE) in a distribution indistinguishable from CS both longitudinally, circumferentially, and radially across the LV segments. LGE mass averaged 17.4 ± 6.3% of LV mass in GCM vs 25.0 ± 13.4% in CS (P = 0.037). Involvement of insertion points extending across the septum into the right ventricular wall, the “hook sign” of CS, was present in 53% of GCM and 50% of CS. Conclusion In GCM, CMR findings are qualitatively indistinguishable from CS despite myocardial inflammation being clinically more acute and injurious. When matched for LV dysfunction and presenting features, LV size and LGE mass are smaller in GCM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac magnetic resonance in giant cell myocarditis: a matched comparison with cardiac sarcoidosis

Pöyhönen

Nordenswan

Lehtonen

et al. 2023

European Heart Journal - Cardiovascular Imaging

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“…LGE in myocarditis is typically observed in the subepicardial myocardium. However, subendocardial LGE was recently reported as a severe phenotype of myocarditis, which should be differentiated from ischemic cardiomyopathies ( 91 ). Of note, LGE patterns of nonischemic cardiomyopathies mentioned above are not specific.…”

Section: Detection: Laboratory Biomarkers and Imaging Techniquesmentioning

confidence: 99%

Detection of myocardial fibrosis: Where we stand

Zhu

Zhao

Lü

2022

Front. Cardiovasc. Med.

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Myocardial fibrosis, resulting from the disturbance of extracellular matrix homeostasis in response to different insults, is a common and important pathological remodeling process that is associated with adverse clinical outcomes, including arrhythmia, heart failure, or even sudden cardiac death. Over the past decades, multiple non-invasive detection methods have been developed. Laboratory biomarkers can aid in both detection and risk stratification by reflecting cellular and even molecular changes in fibrotic processes, yet more evidence that validates their detection accuracy is still warranted. Different non-invasive imaging techniques have been demonstrated to not only detect myocardial fibrosis but also provide information on prognosis and management. Cardiovascular magnetic resonance (CMR) is considered as the gold standard imaging technique to non-invasively identify and quantify myocardial fibrosis with its natural ability for tissue characterization. This review summarizes the current understanding of the non-invasive detection methods of myocardial fibrosis, with the focus on different techniques and clinical applications of CMR.

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Prognosis evaluation of chronic inflammatory cardiomyopathy with ring‐like late gadolinium enhancement

Wang

Gao

et al. 2023

ESC Heart Failure

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Aims Ring‐like late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging is a special LGE pattern in patients with chronic inflammatory cardiomyopathy (infl‐CMP), which is associated with cardiac dysfunction and ventricular remodelling and attributed to viral infection followed by bacterial and parasitic infections. Data on the combination of CMR imaging and clinical parameters that can add long‐term prognostic value in patients with infl‐CMP are still rare. We aimed to evaluate the prognostic value of CMR in risk stratification in this kind of patients. Methods and results A total of 319 consecutive patients with clinically suspected myocarditis were retrospectively identified. Forty‐seven patients with ring‐like LGE on CMR who diagnosed as infl‐CMP, and 72 patients with other LGE pattern were eligible for standardized follow‐up. The left ventricle (LV) and right ventricle function and mass were analyses by CMR. Myocardial strain of the ventricles was evaluated by feature tracking. Major (cardiac death, resuscitated cardiac arrest, ventricular assist device, transplantation, and appropriate implantable cardioverter‐defibrillator shock) and minor (rehospitalization due to heart failure and sustained atrial fibrillation) adverse cardiovascular events were assessed during follow‐up since the date of nCMR examination. Cox proportional hazards model was used to investigate which of the prognostic factors identified by univariable analysis were significantly associated with cardiac events. In the ring‐like LGE group, adverse cardiac events occurred in 14 (31.11%) patients, including 7 deaths (15.56%), 6 (13.33%) heart‐failure hospitalizations, and 1 (2.22%) case of sustained atrial fibrillation during the mean follow‐up period of 70.15 ± 45.68 months (interquartile range: 32.83–103.71 months). No major or minor adverse cardiac event occurred in the other LGE pattern group, except rehospitalization in one patient due to arrhythmia. Further analyses of ring‐like LGE group by univariable and Multivariable Cox proportional hazard regression analysis showed that body mass index (BMI) (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.40–0.73, P = 0.000), right ventricle cardiac index (RVCI) (HR: 0.31, 95% CI: 0.14–0.71, P = 0.002), LV basal peak circumferential strain (LV‐PCSbasal) (HR: 1.26, 95% CI: 1.11–1.43, P = 0.000) were independently associated with the long‐term outcome. Receiver operator characteristic curve indicated that the cut‐off of LV‐PCSBasal was −7.95%, and it has added prognostic value to BMI and RVCI. Conclusions For infl‐CMP patients with ring‐like LGE on CMR, low BMI and RVCI were associated with a poor prognosis. LV‐PCSBasal with a cut‐off of −7.95% can add prognostic value for patients with infl‐CMP who have ring‐like LGE.

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Subendocardial Involvement as an Underrecognized Cardiac MRI Phenotype in Myocarditis

Cited by 11 publications

References 30 publications

Cardiac magnetic resonance in giant cell myocarditis: a matched comparison with cardiac sarcoidosis

Cardiac magnetic resonance in giant cell myocarditis: a matched comparison with cardiac sarcoidosis

Detection of myocardial fibrosis: Where we stand

Prognosis evaluation of chronic inflammatory cardiomyopathy with ring‐like late gadolinium enhancement

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