Outcomes by cardiovascular magnetic resonance in patients with clinically suspected myocardial inflammation

Myocardial inflammation is a key driver of adverse outcomes; yet its clinical recognition remains challenging because of heterogeneous presentation and non-standardised prognostic frameworks. While prior studies linked troponin and late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging (CMR) to outcomes, the relative prognostic value of individual non-invasive markers has not been systematically evaluated. We systematically evaluated the prognostic value of biomarkers and non-invasive imaging variables in patients with clinically suspected myocardial inflammation presenting to tertiary centres and referred for CMR diagnostic evaluation. The primary endpoint was major adverse cardiovascular events (MACE). A total of 722 patients (median age: 50 years [IQR: 40–61]; 422 males [58%]) were included. Over a median follow-up of 19 months (IQR: 15–23), 64 patients (9%) experienced MACE. In univariable analyses, age, haematocrit, C-reactive protein, high-sensitivity troponin T (hs-TropT), ventricular function, cardiac volumes and mass, late gadolinium enhancement (LGE), and native T1 and T2 values were associated with the endpoint. In multivariable Cox regression, native T2, hs-TropT, and LGE were independently predictive of MACE (model χ² = 81.64, p < 0.001). Patients with high-grade myocardial inflammation had the highest mid-term event risk (p < 0.001). Among patients with negative troponin, T2 and left ventricular end-diastolic volume (LVEDV), but not LGE, were predictive of MACE. In patients with clinically suspected myocardial inflammation, standardised CMR-based markers provide independent and incremental prognostic information, supporting their role in improved risk stratification beyond composite criteria.