Utility of cardiac MRI in paediatric myocarditis

Hales-Kharazmi, Alice; Hirsch, Nina; Kelleman, Michael; Slesnick, Timothy; Deshpande, Shriprasad

doi:10.1017/s1047951117001093

Cited by 13 publications

(6 citation statements)

References 17 publications

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“…The Lake Louise criteria have been validated in pediatrics mainly from case reports 516 or single-center series with relatively small populations. 510,[517][518][519][520] There has been one retrospective multicenter study that has evaluated CMR techniques in children with myocarditis which included 13 centers and 143 subjects 521 and although there was variability in tissue characterization protocols among centers, overall sensitivity for CMR positive myocarditis was high (82%).…”

Section: • Risk Stratification and Prognostication • Guiding Subseque...mentioning

confidence: 99%

Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association

Vaiyani

Anwar

Broberg

et al. 2022

Circ: Cardiovascular Imaging

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Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.

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Section: • Risk Stratification and Prognostication • Guiding Subseque...mentioning

confidence: 99%

Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association

Vaiyani

Anwar

Broberg

et al. 2022

Circ: Cardiovascular Imaging

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“…In one study, CMR was reported to have a low yield in diagnosing the severity of acute myocarditis and does not predict outcomes in children [ 23 ]. However, this study was likely underpowered to detect the outcome.…”

Section: Cmr Findings Of Myocardial Inflammation and Pathological Cor...mentioning

confidence: 99%

Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C

et al. 2022

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Myocarditis comprises many clinical presentations ranging from asymptomatic to sudden cardiac death. The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. Echocardiography is the primary tool to detect ventricular wall motion abnormalities, pericardial effusion, valvular regurgitation, and impaired function. The advancement of cardiac magnetic resonance (CMR) imaging has been helpful in clinical practice for diagnosing myocarditis. A recent Scientific Statement by the American Heart Association suggested CMR as a confirmatory test to diagnose acute myocarditis in children. However, standard CMR parametric mapping parameters for diagnosing myocarditis are unavailable in pediatric patients for consistency and reliability in the interpretation. The present review highlights the unmet clinical needs for standard CMR parametric criteria for diagnosing acute and chronic myocarditis in children and differentiating dilated chronic myocarditis phenotype from idiopathic dilated cardiomyopathy. Of particular relevance to today’s practice, we also assess the potential and limitations of CMR to diagnose acute myocarditis in children exposed to severe acute respiratory syndrome coronavirus-2 infections. The latter section will discuss the multi-inflammatory syndrome in children (MIS-C) and mRNA coronavirus disease 19 vaccine-associated myocarditis.

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“…Cardiac MRI has evolved as a useful diagnostic tool in the evaluation of suspected myocarditis as endomyocardial biopsy has been increasingly avoided [25][26][27][28][29][30]. Despite the increased role of MRI, a clear connection has yet to be made between specific findings on MRI, disease course, and outcomes [31][32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

“…Myocardial inflammation and fibrosis are visualized on cardiac MRI using late gadolinium enhancement (LGE) sequences [32]. Nonetheless, the specific association of LGE with adverse outcomes in myocarditis remains undefined [25][26][27][28][30][31][32][33][34]. Previous studies have confirmed though that the development of VT in myocarditis is associated with worse outcomes and increased resource utilization [36][37][38].…”

Section: Introductionmentioning

confidence: 99%

Computational Identification of Ventricular Arrhythmia Risk in Pediatric Myocarditis

et al. 2019

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Introduction: Children with myocarditis have increased risk of ventricular tachycardia (VT) due to myocardial inflammation and remodeling. There is currently no accepted method for VT risk stratification in this population. We hypothesized that personalized models developed from cardiac late gadolinium enhancement magnetic resonance imaging (LGE-MRI) could determine VT risk in patients with myocarditis using a previously-validated protocol. Methods: Personalized three-dimensional computational cardiac models were reconstructed from LGE-MRI scans of 12 patients diagnosed with myocarditis. Four patients with clinical VT and eight patients without VT were included in this retrospective analysis. In each model, we incorporated a personalized spatial distribution of fibrosis and myocardial fiber orientations. Then, VT inducibility was assessed in each model by pacing rapidly from 26 sites distributed throughout both ventricles. Results: Sustained reentrant VT was induced from multiple pacing sites in all patients with clinical VT. In the eight patients without clinical VT, we were unable to induce sustained reentry in our simulations using rapid ventricular pacing. Conclusion: Application of our non-invasive approach in children with myocarditis has the potential to correctly identify those at risk for developing VT.

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Utility of cardiac MRI in paediatric myocarditis

Abstract: In paediatric myocarditis, cardiac MRI is not used uniformly, has a low yield, and does not predict worse outcomes. Future research should evaluate clinical decision-making and the cost-benefit analysis of cardiac MRI in the diagnosis of paediatric myocarditis.

Cited by 13 publications

References 17 publications

Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C

Computational Identification of Ventricular Arrhythmia Risk in Pediatric Myocarditis

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