Abstract 15752: The Role of Cardiac MRI in Children with Acute Myocarditis
Background: The utility of Cardiac MRI (CMR) has been reported in adults with myocarditis (MYO) to distinguish from acute coronary syndrome, yet little data exist in children.
Hypothesis: We hypothesized that CMR would identify abnormalities in the myocardium of children with clinically diagnosed MYO.
Methods: All patients who underwent CMR with a clinical diagnosis of MYO from 1/07 -12/10 underwent chart review for demographics, clinical symptoms, review of peak serum markers, lowest Echo % EF, and highest LVEDD Z score. CMR evaluation included RV and LV systolic functional analysis, edema and delayed enhancement imaging.
Results: CMR was performed in 13 children (12 boys), and serial CMRs were performed in 6. Mean age was 14.1 years at diagnosis. Clinical prodrome was chest pain in 10, heart failure in 2, and arrhythmia in 1. Peak troponin was 6.9-71.5, mean =28.4, peak CRP 2.2-39, mean =8.9, and peak BNP 50.4-4435, mean=1025. Cardiac MRI was performed 1 to 15 days after acute illness onset, and mean 4.1 days after hospitalization. Initial Echo EF was < 50% in only 3 pts; yet, mean LVEDD Z score was 1.30±0.95. Treatment included IVIG alone in 2, steroids alone in 2, and IVIG +steroids in 6. CMR confirmed RV or LV systolic dysfunction in 3 of 13 (23%) patients, edema in 4/13 (31%), and delayed enhancement in 10/13 (77%) primarily in the LV. Follow-up CMR in 6 patients showed normal systolic function in all; there was persistent delayed enhancement with improvement in 4 and normalization in 2.
Conclusion: In conclusion, CMR is feasible and detected abnormalities in children with clinically diagnosed myocarditis, as late as 2 weeks after hospitalization and persisted in patients at follow-up. A prospective study with biopsy/MRI correlation is planned to further delineate the specificity /sensitivity of CMR in children with MYO. CMR may be a useful tool to aid in the diagnosis of acute myocarditis in children and follow-up during the recovery phase.
- © 2011 by American Heart Association, Inc.