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Popa A, Cionca C, Agoston R, Rusu F, Tarcau BM, Negru A, Orzan RI, Agoston-Coldea L. The Role of Magnetic Resonance Imaging in Risk Stratification of Patients with Acute Myocarditis. Diagnostics (Basel) 2024; 14:1426. [PMID: 39001316 PMCID: PMC11241337 DOI: 10.3390/diagnostics14131426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Cardiac magnetic resonance (cMRI) is often used to diagnose acute myocarditis (AM). It is also performed after 6 months to monitor myocardial involvement. However, the clinical and predictive relevance of the 6-month cMRI is uncertain. OBJECTIVE We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode. MATERIALS AND METHODS We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months. RESULTS Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p < 0.001), myocardial edema (p < 0.001), presence of LGE (p < 0.05) and LGE mass (p < 0.01), native T1 mapping (p < 0.001), and presence of pericardial collection (p ≤ 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11-1.99], p < 0.001), myocardial edema (OR = 1.70 [1.14-209.3], p < 0.001), and prolonged native T1 (OR = 0.97 [0.88-3.06], p < 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors. CONCLUSIONS LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.
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Affiliation(s)
- Alexandra Popa
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Carmen Cionca
- Department of Radiology, Affidea Hiperdia Diagnostic Imaging Centre, 400487 Cluj-Napoca, Romania
| | - Renata Agoston
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Flaviu Rusu
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Bogdan Mihai Tarcau
- Doctoral School of Biomedical Science, University of Oradea, 410087 Oradea, Romania
| | - Andra Negru
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Rares Ilie Orzan
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", 400162 Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Department of Radiology, Affidea Hiperdia Diagnostic Imaging Centre, 400487 Cluj-Napoca, Romania
- Department of Internal Medicine, Emergency County Hospital, 400006 Cluj-Napoca, Romania
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Bohbot Y, Pezel T, Demirkıran A, Androulakis E, Houshmand G, Szabo L, Manka R, Botezatu SB, Rodríguez-Palomares JF, Biering-Sørensen T, Podlesnikar T, Dweck MR. European Association of Cardiovascular Imaging survey on cardiovascular multimodality imaging in acute myocarditis. Eur Heart J Cardiovasc Imaging 2024; 25:892-900. [PMID: 38568982 DOI: 10.1093/ehjci/jeae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS To assess the current role of cardiac imaging in the diagnosis, management, and follow-up of patients with acute myocarditis (AM) through a European Association of Cardiovascular Imaging survey. METHODS AND RESULTS A total of 412 volunteers from 74 countries responded to the survey. Most participants worked in tertiary centres (56%). All participants had access to echocardiography, while 79 and 75% had access to cardiac computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR), respectively. Less than half (47%) had access to myocardial biopsy, and only 5% used this test routinely. CMR was performed within 7 days of presentation in 73% of cases. Non-ischaemic late gadolinium enhancement (LGE, 88%) and high-signal intensity in T2-weighted images (74%) were the most used diagnostic criteria for AM. CCTA was preferred to coronary angiography by 47% of participants to exclude coronary artery disease. Systematic prescription of beta-blockers and angiotensin-converting enzyme inhibitors was reported by 38 and 32% of participants. Around a quarter of participants declared considering LGE burden as a reason to treat. Most participants (90%) reported performing a follow-up echocardiogram, while 63% scheduled a follow-up CMR. The main reason for treatment discontinuation was improvement of left ventricular ejection fraction (89%), followed by LGE regression (60%). In two-thirds of participants, the decision to resume high-intensity sport was influenced by residual LGE. CONCLUSION This survey confirms the high utilization of cardiac imaging in AM but reveals major differences in how cardiac imaging is used and how the condition is managed between centres, underlining the need for recommendation statements in this topic.
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Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 80000, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, 80000 Amiens, France
| | - Théo Pezel
- Université Paris Cité, Department of Cardiology, University Hospital of Lariboisiere, (Assistance Publique des Hôpitaux de Paris, AP-HP), 75010 Paris, France
- Inserm MASCOT-UMRS 942, University Hospital of Lariboisiere, 75010 Paris, France
- MIRACL.ai laboratory, Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence, University Hospital of Lariboisiere (AP-HP), 75010 Paris, France
| | - Ahmet Demirkıran
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Cardiology, Kocaeli Şehir Medical Center, Kocaeli, Turkey
| | - Emmanuel Androulakis
- Department of Cardiology, St George's University, London SW170QT, UK
- Department of Cardiovascular Imaging, Royal Brompton Hospital, Guy's St Thomas NHS Foundation Trust, London SW3 6NP, UK
| | - Golnaz Houshmand
- Rajaie Cardiovascular, Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, EC1M 6BQ London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE London, UK
- Department of Cardiology, Semmelweis University, Budapest, Hungary
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Simona B Botezatu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Bucharest, Romania
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - José F Rodríguez-Palomares
- Cardiovascular Imaging Unit, Cardiology Department, Hospital Universitari Vall Hebrón, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Bellaterra, Spain
- CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, 2000 Maribor, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellors Buidling, Little France Crescent, Edinburgh EH16 4SB, UK
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Roy R, Cannata A, Al-Agil M, Ferone E, Jordan A, To-Dang B, Sadler M, Shamsi A, Albarjas M, Piper S, Giacca M, Shah AM, McDonagh T, Bromage DI, Scott PA. Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:366-378. [PMID: 37930743 PMCID: PMC11187717 DOI: 10.1093/ehjqcco/qcad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/21/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION The diagnosis of acute myocarditis (AM) is complex due to its heterogeneity and typically is defined by either Electronic Healthcare Records (EHRs) or advanced imaging and endomyocardial biopsy, but there is no consensus. We aimed to investigate the diagnostic accuracy of these approaches for AM. METHODS Data on ICD 10th Revision(ICD-10) codes corresponding to AM were collected from two hospitals and compared to cardiac magnetic resonance (CMR)-confirmed or clinically suspected (CS)-AM cases with respect to diagnostic accuracy, clinical characteristics, and all-cause mortality. Next, we performed a review of published AM studies according to inclusion criteria. RESULTS We identified 291 unique admissions with ICD-10 codes corresponding to AM in the first three diagnostic positions. The positive predictive value of ICD-10 codes for CMR-confirmed or CS-AM was 36%, and patients with CMR-confirmed or CS-AM had a lower all-cause mortality than those with a refuted diagnosis (P = 0.019). Using an unstructured approach, patients with CMR-confirmed and CS-AM had similar demographics, comorbidity profiles and survival over a median follow-up of 52 months (P = 0.72). Our review of the literature confirmed our findings. Outcomes for patients included in studies using CMR-confirmed criteria were favourable compared to studies with endomyocardial biopsy-confirmed AM cases. CONCLUSION ICD-10 codes have poor accuracy in identification of AM cases and should be used with caution in clinical research. There are important differences in management and outcomes of patients according to the selection criteria used to diagnose AM. Potential selection biases must be considered when interpreting AM cohorts and requires standardization of inclusion criteria for AM studies.
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Affiliation(s)
- Roman Roy
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Antonio Cannata
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Mohammad Al-Agil
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Emma Ferone
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
| | - Antonio Jordan
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Brian To-Dang
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Matthew Sadler
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Aamir Shamsi
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | | | - Susan Piper
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Mauro Giacca
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
| | - Theresa McDonagh
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Daniel I Bromage
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, London SE5 9NU, UK
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Paul A Scott
- King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
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Karur GR, Aneja A, Stojanovska J, Hanneman K, Latchamsetty R, Kersting D, Rajiah PS. Imaging of Cardiac Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis. AJR Am J Roentgenol 2024; 222:e2329870. [PMID: 37753860 DOI: 10.2214/ajr.23.29870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Myocardial fibrosis (MF) is defined as excessive production and deposition of extra-cellular matrix proteins that result in pathologic myocardial remodeling. Three types of MF have been identified: replacement fibrosis from tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative interstitial fibrosis from progressive deposition of nondegradable material such as amyloid. Although echocardiography, nuclear medicine, and CT play important roles in the assessment of MF, MRI is pivotal in the evaluation of MF, with the late gadolinium enhancement (LGE) technique used as a primary end point. The LGE technique focuses on the pattern and distribution of gadolinium accumulation in the myocardium and assists in the diagnosis and establishment of the cause of both ischemic and nonischemic cardiomyopathy. LGE MRI also aids prognostication and risk stratification. In addition, LGE MRI is used to guide the management of patients considered for ablation for arrhythmias. Parametric mapping techniques, including T1 mapping and extracellular volume measurement, allow detection and quantification of diffuse fibrosis, which may not be detected by LGE MRI. These techniques also allow monitoring of disease progression and therapy response. This review provides an update on the imaging of MF, including prognostication and risk stratification tools, electrophysiologic considerations, and disease monitoring.
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Affiliation(s)
- Gauri R Karur
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Ashish Aneja
- Department of Cardiology, MetroHealth System, Cleveland, OH
| | | | - Kate Hanneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, Toronto, ON, Canada
| | | | - David Kersting
- Department of Nuclear Medicine and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
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Bohbot Y, Pezel T. Acute myocarditis: An urgent need for evidence-based recommendations. Arch Cardiovasc Dis 2024; 117:379-381. [PMID: 38797640 DOI: 10.1016/j.acvd.2024.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules-Verne University of Picardie, 80025 Amiens, France; MIRACL.ai laboratory (Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence), University Hospital of Lariboisière, AP-HP, 75010 Paris, France.
| | - Théo Pezel
- MIRACL.ai laboratory (Multimodality Imaging for Research and Analysis Core Laboratory and Artificial Intelligence), University Hospital of Lariboisière, AP-HP, 75010 Paris, France; Department of Cardiology, University Hospital of Lariboisière, AP-HP, Université Paris Cité, 75010 Paris, France; MASCOT-UMRS 942, Inserm, University Hospital of Lariboisière, AP-HP, 75010 Paris, France
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Ammirati E, Camici PG. Relevance to identify patients with uncomplicated presentation at the index hospitalization for suspected acute myocarditis to better plan follow-up. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:411-413. [PMID: 38662473 DOI: 10.1093/ehjacc/zuae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Health Sciences, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Paolo G Camici
- IRCCS San Raffaele Hospital, Cardiovascular Research Center, via Olgettina 60, 20132 Milan, Italy
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Sinigiani G, De Michieli L, De Conti G, Ricci F, De Lazzari M, Migliore F, Perazzolo Marra M, Zorzi A, Corrado D, Cipriani A. Cardiac Magnetic Resonance-Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review. J Cardiovasc Dev Dis 2023; 10:319. [PMID: 37623332 PMCID: PMC10455433 DOI: 10.3390/jcdd10080319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Acute myocardial edema (AME) is increased water content in the myocardium and represents the first and transient pathophysiological response to an acute myocardial injury. In-vivo and non-invasive evaluation is feasible with cardiac magnetic resonance (CMR), which is a powerful imaging technique capable of tissue characterization. In the clinical setting, early demonstration of AME has a recognized diagnostic value for acute coronary syndromes and acute myocarditis, although its prognostic value is not well established. This article provides a comprehensive narrative review on the clinical meaning of AME in heart diseases. In particular, the available evidence of a possible favourable prognostic value in several clinical scenarios is addressed.
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Affiliation(s)
- Giulio Sinigiani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Laura De Michieli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua, 35128 Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
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Mulla W, Segev A, Novak A, Yogev D, Abu-Much A, Fardman A, Massalha E, Goietin O, Kuperstein R, Matetzky S, Grupper A, Afel Y, Herscovici R, Peled-Potashnik Y, Chernomordik F, Brodov Y, Beigel R, Younis A. Significance of Anteroseptal Late Gadolinium Enhancement Among Patients With Acute Myocarditis. Am J Cardiol 2023; 199:18-24. [PMID: 37229967 DOI: 10.1016/j.amjcard.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023]
Abstract
Anteroseptal location of late gadolinium enhancement (LGE) in patients with acute myocarditis (AM) detected by cardiovascular magnetic resonance may indicate an independent marker of unfavorable outcomes according to recent data. We aimed to evaluate the clinical characteristics, management, and inhospital outcomes in patients with AM with positive LGE based on its presence in the anteroseptal location. We analyzed data from 262 consecutive patients hospitalized with a diagnosis of AM with positive LGE within 5 days of hospitalization (n = 425). Patients were divided into 2 groups: those with anteroseptal LGE (n = 25, 9.5%) and those with non-anteroseptal LGE (n = 237, 90.5%). Except for age that was higher in patients with anteroseptal LGE, the demographic and clinical characteristics did not differ significantly between both groups including past medical history, clinical presentation, electrocardiogram parameters, and lab values. Moreover, patients with anteroseptal LGE were more likely to present with reduced left ventricular ejection fraction and to receive congestive heart failure treatments. Although univariate analysis showed that patients with anteroseptal LGE were more likely to have inhospital major adverse cardiac events (28% vs 9%, p = 0.003), there was no difference inhospital outcomes on multivariable analysis between both groups (hazard ratio, 1.17 [95% confidence interval, 0.32 to 4.22], p = 0.81). A higher left ventricular ejection fraction in either echocardiography or cardiovascular magnetic resonance corresponded to better inhospital outcomes regardless of the presence or absence of anteroseptal LGE. In conclusion, the presence of anteroseptal LGE did not confer additional prognostic value for inhospital outcomes.
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Affiliation(s)
- Wesam Mulla
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Amitai Segev
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Amir Novak
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Dean Yogev
- Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Arsalan Abu-Much
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Alexander Fardman
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Eias Massalha
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Orly Goietin
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Raphael Kuperstein
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Shlomi Matetzky
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Avishay Grupper
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yoav Afel
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Romana Herscovici
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yael Peled-Potashnik
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Fernando Chernomordik
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yafim Brodov
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Roy Beigel
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Anan Younis
- Department of Cardiovascular Medicine, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel.
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9
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Short term outcome of myocarditis and pericarditis following COVID-19 vaccines: a cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging 2023; 39:1031-1043. [PMID: 36913155 PMCID: PMC10009344 DOI: 10.1007/s10554-023-02799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
To evaluate clinical and cardiac magnetic resonance (CMR) short-term follow-up (FU) in patients with vaccine-associated myocarditis, pericarditis or myo-pericarditis (VAMP) following COVID-19 vaccination. We retrospectively analyzed 44 patients (2 women, mean age: 31.7 ± 15.1 years) with clinical and CMR manifestations of VAMP, recruited from 13 large tertiary national centers. Inclusion criteria were troponin raise, interval between the last vaccination dose and onset of symptoms < 25 days and symptoms-to-CMR < 20 days. 29/44 patients underwent a short-term FU-CMR with a median time of 3.3 months. Ventricular volumes and CMR findings of cardiac injury were collected in all exams. Mean interval between the last vaccination dose and the onset of symptoms was 6.2 ± 5.6 days. 30/44 patients received a vaccination with Comirnaty, 12/44 with Spikevax, 1/44 with Vaxzevria and 1/44 with Janssen (18 after the first dose of vaccine, 20 after the second and 6 after the "booster" dose). Chest pain was the most frequent symptom (41/44), followed by fever (29/44), myalgia (17/44), dyspnea (13/44) and palpitations (11/44). At baseline, left ventricular ejection fraction (LV-EF) was reduced in 7 patients; wall motion abnormalities have been detected in 10. Myocardial edema was found in 35 (79.5%) and LGE in 40 (90.9%) patients. Clinical FU revealed symptoms persistence in 8/44 patients. At FU-CMR, LV-EF was reduced only in 2 patients, myocardial edema was present in 8/29 patients and LGE in 26/29. VAMPs appear to have a mild clinical presentation, with self-limiting course and resolution of CMR signs of active inflammation at short-term follow-up in most of the cases.
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Urzua Fresno C, Sanchez Tijmes F, Shaw KE, Huang F, Thavendiranathan P, Khullar S, Seidman MA, Hanneman K. Cardiac Imaging in Myocarditis: Current Evidence and Future Directions. Can Assoc Radiol J 2023; 74:147-159. [PMID: 36062360 DOI: 10.1177/08465371221119713] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Myocarditis is defined as a non-ischemic inflammatory disease of the myocardium. It remains a challenge to diagnose given non-specific symptoms and lack of specific blood biomarkers. Cardiac imaging plays an important role in the evaluation of myocarditis with unique strengths and limitations of different imaging modalities, including cardiac magnetic resonance imaging, echocardiography, cardiac computed tomography, and positron emission tomography. The purpose of this review is to discuss the strengths and limitations of various cardiac imaging techniques in the evaluation of myocarditis, review imaging findings in specific causes of myocarditis including COVID-19 and after vaccination, evaluate the role of imaging in differentiating myocarditis from potential mimics and differential considerations, identify current gaps in knowledge, and propose future directions.
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Affiliation(s)
- Camila Urzua Fresno
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
| | - Felipe Sanchez Tijmes
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, Clinica Santa Maria, 33179Universidad de los Andes, Santiago, Chile
| | - Kirsten E Shaw
- Department of Cardiology, 123769Hennepin Healthcare/Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Flora Huang
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
| | - Sharmila Khullar
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, Toronto, ON, Canada
| | - Michael A Seidman
- Department of Laboratory Medicine & Pathobiology, 7938University of Toronto, Toronto, ON, Canada.,Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network (UHN), 7938University of Toronto, Toronto, ON, Canada
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11
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Associated Factors and Clinical Implications of Dynamic Changes in Late Gadolinium Enhancement After Acute Myocarditis. JACC. CARDIOVASCULAR IMAGING 2022:S1936-878X(22)00683-0. [PMID: 36752443 DOI: 10.1016/j.jcmg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/11/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023]
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