Presence of late gadolinium enhancement on CMR in patients with suspected myocarditis was associated with an increased risk of MACE compared to its absence (HR 2.22; 95% CI 1.47-3.35; p<0.001).
Cohort (n=670)
Does CMR tissue characterization with LGE predict major adverse cardiovascular events in patients with suspected myocarditis?
CMR tissue characterization, specifically the presence, pattern, and extent of LGE, provides effective prognostic risk stratification for major adverse cardiovascular events in patients with suspected myocarditis.
Effect estimate: HR 2.22 (95% CI 1.47-3.35)
Absolute Event Rate: 4.8% vs 2.1%
p-value: p=<0.001
BACKGROUND Diagnosing myocarditis is challenged by nonspecific clinical signs and symptoms and low accuracy of endomyocardial biopsy. Cardiac magnetic resonance imaging (CMR) provides both cardiac anatomy and tissue characterization in this setting, but the prognostic value of this method as a primary assessment tool in patients with suspected myocarditis remains limited. OBJECTIVES This study sought to determine cardiac event-free survival of a consecutive cohort with suspected myocarditis with regard to CMR findings. METHODS Six hundred seventy patients with suspected myocarditis underwent CMR including late gadolinium enhancement (LGE) parameters between 2002 and 2015 and were included and followed. We performed multivariable model for major adverse cardiovascular events (MACE) and determined the continuous net reclassification improvement by LGE markers. RESULTS At a median follow-up of 4.7 years (interquartile range IQR: 2.3 to 7.3 years), 98 patients experienced a MACE. Two hundred ninety-four (44%) patients showed LGE presence, which was associated with a more than doubling risk of MACE (hazard ratio HR: 2.22; 95% confidence interval CI: 1.47 to 3.35; p < 0.001). Annualized MACE rates were 4.8% and 2.1% corresponding to LGE presence and absence, respectively (p < 0.001). In the multivariable model, LGE presence maintained significant association with MACE (HR: 1.72; 95% CI: 1.08 to 2.76; p = 0.023). The computed continuous net reclassification improvement was 0.39 (95% CI: 0.10 to 0.67) when LGE presence was added to the multivariable model for MACE. Regarding location and pattern, septal and midwall LGE showed strongest associations with MACE (HR: 2.55; 95% CI: 1.77 to 3.83 and HR: 2.39; 95% CI: 1.54 to 3.69, respectively; both p < 0.001). A patchy distribution portended to a near 3-fold increased hazard to MACE (HR: 2.93; 95% CI: 1.79 to 4.80; p < 0.001). LGE extent (per 10% increase) corresponded to a 79% increase in risk of MACE (HR: 1.79; 95% CI: 1.25 to 2.57; p = 0.002). A normal CMR study corresponded to low annual MACE and death rates of 0.8% and 0.3%, respectively. CONCLUSIONS CMR tissue characterization provides effective risk stratification in patients with suspected myocarditis.
Gräni et al. (2017) conducted a cohort in Suspected myocarditis (n=670). Late gadolinium enhancement (LGE) presence on CMR vs. LGE absence was evaluated on Major adverse cardiovascular events (MACE) (HR 2.22, 95% CI 1.47-3.35, p=<0.001). Presence of late gadolinium enhancement on CMR in patients with suspected myocarditis was associated with an increased risk of MACE compared to its absence (HR 2.22; 95% CI 1.47-3.35; p<0.001).