Cardiac MRI in infarct-like myocarditis: transmural extension of late gadolinium enhancement is associated with worse outcomes.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2024-10-11 DOI:10.1186/s13244-024-01832-3

Alexander Isaak, Johannes Wirtz, Dmitrij Kravchenko, Narine Mesropyan, Leon M Bischoff, Simon Bienert, Leonie Weinhold, Claus C Pieper, Ulrike Attenberger, Can Öztürk, Sebastian Zimmer, Daniel Kuetting, Julian A Luetkens

{"title":"Cardiac MRI in infarct-like myocarditis: transmural extension of late gadolinium enhancement is associated with worse outcomes.","authors":"Alexander Isaak, Johannes Wirtz, Dmitrij Kravchenko, Narine Mesropyan, Leon M Bischoff, Simon Bienert, Leonie Weinhold, Claus C Pieper, Ulrike Attenberger, Can Öztürk, Sebastian Zimmer, Daniel Kuetting, Julian A Luetkens","doi":"10.1186/s13244-024-01832-3","DOIUrl":null,"url":null,"abstract":"Objectives: To assess the prognostic value of cardiac MRI (CMR) parameters for the occurrence of major adverse cardiac events (MACE) in patients with infarct-like myocarditis.Methods: In this retrospective single-center study, patients with CMR-confirmed acute myocarditis with infarct-like presentation were identified (2007-2020). Functional and structural parameters were analyzed including late gadolinium enhancement (LGE). The primary endpoint was the occurrence of MACE up to 5 years after discharge.Results: In total, 130 patients (mean age, 40 ± 19 years; 97 men, 75%) with infarct-like myocarditis were included. CMR was conducted a median of 3 days (interquartile range [IQR], 1-5) after symptom onset. MACE occurred in 18/130 patients (14%) during a median follow-up of 19.3 months (IQR, 4.5-53). The median extent of LGE was 7% (IQR, 4-10). LGE affected the subepicardium in 111/130 patients (85%), the midwall in 45/130 patients (35%), and both the subepicardium and midwall in 27/130 patients (21%). Transmural extension of non-ischemic LGE lesions was observed in 15/130 patients (12%) and septal LGE in 42/130 patients (32%). In univariable Cox regression analysis, a significant association was found between the occurrence of MACE and both, quantified LGE extent and transmural LGE pattern. In multivariable analysis, transmural extension of LGE was an independent predictor for MACE (hazard ratio, 6.34; 95% confidence interval: 2.29-17.49; p < 0.001). Patients with the transmural extension of LGE had a shorter event-free time on Kaplan-Meier analysis (log-rank p < 0.001).Conclusions: MACE occurred in 14% of patients with infarct-like myocarditis during follow-up. A transmural extension of non-ischemic LGE was associated with a worse long-term prognosis.Critical relevance statement: CMR-based assessment of transmural extension of non-ischemic LGE holds the potential to serve as an easily assessable marker for risk stratification in patients with infarct-like myocarditis.Key points: The prognostic value of CMR was studied in patients with infarct-like myocarditis. The extent of LGE and transmural extension were linked to adverse cardiac events. Transmural non-ischemic LGE can serve as an easily assessable prognostic marker.","PeriodicalId":13639,"journal":{"name":"Insights into Imaging","volume":"15 1","pages":"246"},"PeriodicalIF":4.1000,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469985/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Insights into Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13244-024-01832-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: To assess the prognostic value of cardiac MRI (CMR) parameters for the occurrence of major adverse cardiac events (MACE) in patients with infarct-like myocarditis.

Methods: In this retrospective single-center study, patients with CMR-confirmed acute myocarditis with infarct-like presentation were identified (2007-2020). Functional and structural parameters were analyzed including late gadolinium enhancement (LGE). The primary endpoint was the occurrence of MACE up to 5 years after discharge.

Results: In total, 130 patients (mean age, 40 ± 19 years; 97 men, 75%) with infarct-like myocarditis were included. CMR was conducted a median of 3 days (interquartile range [IQR], 1-5) after symptom onset. MACE occurred in 18/130 patients (14%) during a median follow-up of 19.3 months (IQR, 4.5-53). The median extent of LGE was 7% (IQR, 4-10). LGE affected the subepicardium in 111/130 patients (85%), the midwall in 45/130 patients (35%), and both the subepicardium and midwall in 27/130 patients (21%). Transmural extension of non-ischemic LGE lesions was observed in 15/130 patients (12%) and septal LGE in 42/130 patients (32%). In univariable Cox regression analysis, a significant association was found between the occurrence of MACE and both, quantified LGE extent and transmural LGE pattern. In multivariable analysis, transmural extension of LGE was an independent predictor for MACE (hazard ratio, 6.34; 95% confidence interval: 2.29-17.49; p < 0.001). Patients with the transmural extension of LGE had a shorter event-free time on Kaplan-Meier analysis (log-rank p < 0.001).

Conclusions: MACE occurred in 14% of patients with infarct-like myocarditis during follow-up. A transmural extension of non-ischemic LGE was associated with a worse long-term prognosis.

Critical relevance statement: CMR-based assessment of transmural extension of non-ischemic LGE holds the potential to serve as an easily assessable marker for risk stratification in patients with infarct-like myocarditis.

Key points: The prognostic value of CMR was studied in patients with infarct-like myocarditis. The extent of LGE and transmural extension were linked to adverse cardiac events. Transmural non-ischemic LGE can serve as an easily assessable prognostic marker.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

心肌梗塞样心肌炎的心脏磁共振成像：晚期钆增强的跨壁扩展与较差的预后有关。

目的评估心脏磁共振成像（CMR）参数对心肌梗死样心肌炎患者发生主要心脏不良事件（MACE）的预后价值：在这项回顾性单中心研究中，确定了经CMR确诊的急性心肌炎并伴有梗死样表现的患者（2007-2020年）。研究分析了包括晚期钆增强（LGE）在内的功能和结构参数。主要终点是出院后5年内MACE的发生率：共纳入 130 名心肌梗死样心肌炎患者（平均年龄 40 ± 19 岁；97 名男性，占 75%）。CMR检查在症状出现后3天（四分位数间距[IQR]，1-5）进行。在中位 19.3 个月（IQR，4.5-53）的随访期间，有 18/130 例患者（14%）发生了 MACE。LGE 的中位范围为 7%（IQR，4-10）。111/130 例患者的 LGE 波及心外膜下（85%），45/130 例患者的 LGE 波及中壁（35%），27/130 例患者的 LGE 波及心外膜下和中壁（21%）。在 15/130 例患者（12%）和 42/130 例患者（32%）中观察到非缺血性 LGE 病变的跨壁扩展，在 42/130 例患者（32%）中观察到室间隔 LGE。在单变量 Cox 回归分析中发现，MACE 的发生与量化的 LGE 范围和经壁 LGE 模式均有显著关联。在多变量分析中，经壁LGE扩展是MACE的独立预测因素（危险比为6.34；95%置信区间：2.29-17.49；P 结论：14%的LGE患者发生了MACE：14%的心肌梗死样心肌炎患者在随访期间发生了MACE。非缺血性 LGE 的跨壁扩展与较差的长期预后有关：基于CMR的非缺血性LGE经壁扩展评估有望成为心肌梗死样心肌炎患者进行风险分层的一个易于评估的标志物：研究了心肌梗死样心肌炎患者CMR的预后价值。LGE的范围和经壁扩展与不良心脏事件有关。跨壁非缺血性 LGE 可作为一种易于评估的预后标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.