Abstract 15783: Diagnostic and Prosnogtic Value of Late Contras-Enhanced Magnetic Resonance in Acute Myopericarditis
Cardiac magnetic resonance (CMR) has become the primary non invasive tool for assessment of myocardial inflammation in patients with suspected acute myocarditis (AM). However its role in the prognosis of myocarditis has not yet been investigated. The aim of this study was to evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance in patients with AM.
Methods: Prospective and clinical observational cohort study of 75 consecutive patients (mean age 33±14 years, 84% male) with AM underwent contrast-enhanced CRM within first month after admission, enrolled between June 2006 and 31 December 2011
Results: Mean follow-up was 72±14 months. Areas of late gadolinium enhancement (LE) were observed in 51 patients (68%) with a subepicardial and focal LE pattern. Forty patients (53%) showed LE in the lateral segments of the left ventricular wall. The median troponin I level and median CK level were associated with LE and the percentage of myocardial mass with LE (R spearmen of 0,71; p<0,001 and 0,64; p<0,001, respectively). The patients with left Ventricular dysfunction (EF≤50%) measured at admission by echocardiography presented more frequently areas of LE in CRM (58, 82±10,37% versus 65.38±5.2%, p=0.003), being the percentage of myocardial mass with LE higher in the group of patients with less ejection fraction (R pearson de 0.518;p=0.004). Therefore, patients with areas of LE had more risk of developing complications (ventricular dysfunction, acute heart failure, pericardial effusion and, arrhythmias), than patients with no LE (Relative Risk for all complications 1,45. IC 95%; p=0,047, RR for letf ventricular dysfunction 1,41; p=0,004. RR for acute heart failure of 1,11; p=0,05).
Conclusions: Late Contras-enhanced CRM is a useful diagnostic tool for detection of lesions after acute myocarditis. The presence of areas of LE and the percentage of myocardial mass with LE is associated with mean elevation of markers of myocardial damage and further deterioration of left ventricular function. Therefore, these patients are at higher risk of complications during hospitalization. Our data suggest that late-contrast enhanced CRM provides relevant prognostic information in patients with acute myocarditis. .
- © 2012 by American Heart Association, Inc.