Key result
Low LGE in fulminant myocarditis is linked to ~5% higher 2-year LVEF vs high LGE.
Why the study?
Due to the low incidence rate of fulminant myocarditis and small sample sizes, knowledge regarding the prognostic role of late gadolinium enhancement in cardiac magnetic resonance for these patients is limited.
Does the extent of late gadolinium enhancement (LGE mass%) on CMR at discharge predict cardiac function recovery in adults with viral fulminant myocarditis?
Cohort (n=44)
No
Does the extent of late gadolinium enhancement (LGE mass%) on CMR at discharge predict cardiac function recovery in adults with viral fulminant myocarditis?
Absolute Event Rate: 60.62% vs 55.74%
p-value: p=0.031
LGE mass% at discharge provides significant prognostic information regarding long-term cardiac function recovery in patients with fulminant myocarditis.
LGE at discharge may aid prognostication for LVEF recovery in fulminant myocarditis; leaves open prospective validation before guiding care.
Background: Myocardial fibrosis, as quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), provides valuable prognostic information for patients with myocarditis. However, due to the low incidence rate of fulminant myocarditis (FM) and accordingly small sample size, the knowledge about the role of LGE to patients with FM is limited. Methods and results: A total of 44 adults with viral-FM receiving the Chinese treating regimen were included in this retrospective study. They were divided into the low LGE group and the high LGE group according to the ratio of LGE to left ventricular mass (LGE mass%). CMR exams and LGE were performed after hemodynamic assistance at discharge in all patients with FM. Routine echocardiography parameters and global longitudinal strain (GLS) at discharge and at 2-year follow-up were obtained and then compared. Both left ventricular ejection fraction (LVEF) and GLS showed no significant difference in both groups at discharge, whereas significant differences were observed at 2-year follow-up between two groups. Moreover, there were significant improvements of LVEF and GLS in the low LGE group, but not in the high LGE group during the 2-year period. Furthermore, LGE mass% was negatively correlated with GLS and LVEF. Conclusions: There were two distinct forms of LGE presentation in patients with FM. Moreover, the cardiac function of patients with low LGE was significantly better than those with high LGE at 2-year follow-up. LGE mass% at discharge provided significant prognosis information about cardiac function of patients with FM.
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Jiang et al. (2023) conducted a cohort in Fulminant myocarditis (n=44). Low late gadolinium enhancement (LGE mass% ≤20) vs. High late gadolinium enhancement (LGE mass% >20) was evaluated on Left ventricular ejection fraction (LVEF) at 2-year follow-up (p=0.031). In patients with fulminant myocarditis, low late gadolinium enhancement was associated with significantly better left ventricular ejection fraction (60.62% vs 55.74%) at 2-year follow-up compared to high LGE.
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