Key result
Multiparametric CMR differentiates severe from mild myocarditis via higher T2 and decreased LV strain.
Why the study?
Does multiparametric cardiac magnetic resonance differentiate between mild and severe acute myocarditis?
Case Report (n=2)
No
Does multiparametric cardiac magnetic resonance differentiate between mild and severe acute myocarditis?
Multiparametric CMR provides noninvasive, repeatable assessment of myocardial characteristics and function, aiding in the diagnosis, severity assessment, and follow-up of acute myocarditis.
CMR may enable noninvasive myocarditis diagnosis; leaves open prospective validation versus biopsy.
The pathophysiology of myocarditis is associated with mild inflammation and may progress silently, or in severe cases such as fulminant myocarditis, may lead to sudden hemodynamic compromise. An invasive myocardial biopsy is generally required for a definitive myocarditis diagnosis. Alternatively, cardiac magnetic resonance (CMR), which evaluates myocardial characteristics and cardiac function, can be used as a noninvasive tool for diagnosing myocarditis. We describe the cases of a 49-year-old woman with mild acute eosinophilic myocarditis and a 48-year-old man with severe acute lymphocytic myocarditis. CMR was performed during the acute and convalescent phases in both cases. Compared with mild myocarditis, CMR in severe myocarditis showed higher T2 values and decreased left ventricular and atrial volumes and strains; however, the right ventricular strain was preserved. Late gadolinium enhancement showed faint contrast enhancement in the whole and strong enhancement in the local myocardium. Follow-up CMR showed recovery from myocardial inflammation and cardiac function. Some late gadolinium enhancement persisted whereas acute inflammation-associated enhancement disappeared. This case report highlights the differences between the cardiac parameters of patients with mild and severe myocarditis. Severe myocardial inflammation can be caused by severe heart failure owing to the concurrent reduction of cardiac function and compliance. Additionally, preserved right ventricular strain may predict cardiac function recovery in acute myocarditis. Noninvasive and repeatable CMR provides information on myocardial characteristics, cardiac function, and hemodynamics in a single scan at that time, which is useful not only for diagnosis but also for severity assessment and patient management in acute myocarditis.
No takes yet. Share an insight, caveat, or question.
Arai et al. (2023) conducted a case report in Acute myocarditis (n=2). Multiparametric cardiac magnetic resonance vs. Mild vs severe myocarditis was evaluated on Cardiac magnetic resonance parameters (T2 values, ventricular/atrial strains, and late gadolinium enhancement). Multiparametric cardiac magnetic resonance differentiated severe from mild myocarditis by revealing higher T2 values, decreased left ventricular and atrial strains, and preserved right ventricular strain.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: