Meeting ESC criteria or updated Lake-Louise criteria independently predicted adverse events in patients with suspected myocarditis (HR 3.87; 95% CI 1.22-12.2 and HR 2.53; 95% CI 1.83-3.49).
Cohort (n=1,050)
Yes
Do different diagnostic criteria for myocarditis (ESC, LLC, AHA, expert consensus) predict adverse clinical outcomes in patients with suspected myocarditis?
ESC clinical criteria and CMR-based Lake-Louise criteria provide independent and complementary prognostic value for risk stratification in patients with suspected myocarditis.
Hazard Ratio: 3.87 (95% CI 1.22–12.2)
p-value: p=0.021
BACKGROUND The European Society of Cardiology (ESC), the American College of Cardiology, the American Heart Association, and expert consensus documents provide different diagnostic criteria for myocarditis. Their overlap and prognostic value have never been compared. OBJECTIVES This study aims to assess and compare the predictive value of ESC criteria for clinically suspected myocarditis, updated Lake-Louise criteria (LLC), American Heart Association criteria for probable acute myocarditis (pAM), and expert consensus criteria for acute myocarditis (AM) and complicated myocarditis (CM). METHODS Patients with a clinical suspicion of myocarditis referred for cardiac magnetic resonance were enrolled at 2 centers. Those with any prior cardiomyopathy were excluded. The association of composite outcome events (heart failure hospitalization, recurrent myocarditis, sustained ventricular tachycardia, or death) with ESC diagnostic criteria, LLC, pAM, AM, and CM were compared. RESULTS Among 1,557 consecutive patients referred for cardiac magnetic resonance with possible myocarditis, 1,050 (62.6% male; 48.9 ± 16.8 years of age) were without an alternative diagnosis. Of those, 938 (89.3%) met ESC criteria for clinically suspected myocarditis, 299 (28.5%) LLC, and 356 (33.9%), 216 (20.6%), and 77 (7.3%) pAM, AM, and CM, respectively. Adverse events occurred in 161 patients (15.3%) during a median follow-up of 3.4 years. The highest annualized event rates (6.6%) were observed in patients meeting LLC, whereas negative ESC criteria indicated excellent prognosis (0.7% annualized event rate). Among all myocarditis definitions, ESC criteria and LLC were the strongest multivariable outcome predictors and had independent and incremental prognostic value (HRadjusted: 3.87; 95% CI: 1.22-12.2; P = 0.021, and HRadjusted: 2.53; 95% CI: 1.83-3.49; P < 0.001, respectively) when adjusted for clinical characteristics. CONCLUSIONS In a real-world cohort of patients with possible myocarditis, diagnosis was reached in most patients using ESC criteria whereas only approximately one-quarter of patients reached a diagnosis with LLC. The independent prognostic value of ESC-criteria and LLC highlights the complementary role of clinical and CMR-based findings in the diagnosis and risk stratification of myocarditis.
“From the comparison of the different used diagnostic tools, we can derive novel approaches for future research and development. Next, we will determine how artificial intelligence (AI) can assist us in a rapid and comprehensive evaluation of the many different clinical parameters and image data.”
Bernhard et al. (Mon,) conducted a cohort in Clinically suspected myocarditis (n=1,050). ESC criteria for clinically suspected myocarditis vs. Negative ESC criteria was evaluated on Composite of heart failure hospitalization, recurrent myocarditis, sustained ventricular tachycardia, or death (HR 3.87, 95% CI 1.22-12.2, p=0.021). Meeting ESC criteria or updated Lake-Louise criteria independently predicted adverse events in patients with suspected myocarditis (HR 3.87; 95% CI 1.22-12.2 and HR 2.53; 95% CI 1.83-3.49).