Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis

Figures

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  Fig. 1. The degree of agreement between old and new LLC was good for the IL presentation (57.4% vs 66.7%, respectively) and fair for CM and AR onsets (17.9% vs 60.7% and 15% vs 35%, respectively). Cohen’s k was 0.57 considering the overall clinical patterns (38.2% vs 58.8%). LLC Lake Louise Criteria, IL infarct-like, CM cardiomyopathic, AR arrhythmic

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  Fig. 2. Comparison between old and new LLC as regards the diagnostic accuracy. DA was the same for oLLC and nLLC in IL onset. A great increase in DA of nLLC for CM onset (41.60% of oLLC vs 66.70% of nLLC) was found. The overall DA for oLLC was 52.40% vs 71.40% for the new criteria. LLC Lake Louise Criteria, DA diagnostic accuracy, CM cardiomyopathic

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  Fig. 3. 43-year-old male patient with acute chest pain and T-Troponine release (0.05 mcg/L). The EGE ratio (a) was 5.4 with hyperemia of the anterior and infero-septal segments on mid-ventricular plane (a, red arrows). Oedema (b) with a patchy distribution on the antero-lateral and infero-septal segments (b, white arrows), was confirmed by a T2 ratio of 2.4 on mid-ventricular plane. A non-ischemic LGE (c) was found in the inferior and infero-septal segments (c, yellow arrows) with a subepicardial distribution. Native T1 (d, mean value of 1073 ms), ECV (e, mean value of 29%) and T2 mapping (f, mean value of 51 ms) were all increased, confirming the positivity of both old and new LLC. EGE early gadolinium enhancement, STIR short tau inversion recovery, LGE late gadolinium enhancement, ECV extracellular volume fraction, LLC Lake Louise Criteria

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  Fig. 4. 65-years old female with reduced EF (24%), LV dilation (EDV/BSA: 153 ml/mq) and no significant coronary artery disease. No hyperaemia (a, EGE ratio < 4), neither oedema (b, T2 ratio < 2) nor LGE (c) was found: oLLC were negative for suspected acute myocarditis. Native T1 was severely increased (d) with a mid-ventricular mean value of 1190 ms, ECV (e) mean value was 35% and T2 mapping was slightly increased (f, mean value: 52 ms). Both T1 and T2 criterion were positive according to nLLC and the diagnosis of viral myocarditis was confirmed by EMB. EF ejection fraction, EDV end diastolic volume, BSA body surface area, EGE early gadolinium enhancement, STIR short tau inversion recovery, LGE late gadolinium enhancement, oLLC old Lake Louise Criteria, ECV extracellular volume, nLLC new Lake Louise Criteria, EMB endomyocardial biopsy