Key result
Midwall LGE on early CMR linked to ~2.9-fold higher adverse outcomes in pediatric myocarditis.
Why the study?
Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) plays an important diagnostic role in pediatric acute myocarditis, the prognostic significance of specific LGE patterns such as midwall LGE remained uncertain.
Does the presence of midwall late gadolinium enhancement on early cardiac magnetic resonance predict long-term adverse outcomes (dilated cardiomyopathy, arrhythmogenic cardiomyopathy, or recurrent myocarditis) in pediatric patients with acute myocarditis?
Cohort (n=81)
Does the presence of midwall late gadolinium enhancement on early cardiac magnetic resonance predict long-term adverse outcomes (dilated cardiomyopathy, arrhythmogenic cardiomyopathy, or recurrent myocarditis) in pediatric patients with acute myocarditis?
In pediatric patients with CMR-confirmed acute myocarditis, the presence of midwall LGE on early imaging is associated with a nearly threefold increased hazard of developing cardiomyopathy or recurrent myocarditis, aiding in early risk stratification.
Answers are grounded in this paper and cite their sources.
May aid risk stratification with early CMR in pediatric myocarditis; leaves open prospective validation before guiding management.
Background Pediatric acute myocarditis is associated with variable recovery and risk of adverse cardiac outcomes. Late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) plays an important diagnostic role, but the prognostic significance of specific LGE patterns in children remains uncertain. Purpose To evaluate whether midwall LGE on early CMR is associated with long-term adverse outcomes in pediatric myocarditis. Methods A retrospective cohort study was conducted, including patients <21 years old with myocarditis determined by Lake Louise criteria on CMR performed within 30 days of clinical diagnosis. Midwall LGE was defined as mid-myocardial LGE on visual assessment. A composite adverse endpoint was defined as the diagnosis of dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), or recurrent myocarditis. Associations between midwall LGE and adverse outcomes were evaluated using univariate Cox proportional hazards regression. Event-free survival was assessed using Kaplan–Meier analysis (time 0 = date of diagnosis) with log-rank testing. Results A total of 81 patients met inclusion criteria with the initial CMR performed at a median age of 14.8 years (IQR 11.8-16.6), and 23 (28%) were female. Midwall LGE was present in 25 patients (31%; Table 1). Over a median follow-up period of 2.2 years (IQR 0.7-4.3), 14 patients (17%) experienced a composite adverse endpoint, including DCM (n=6; 1 death), ACM (n=6; 2 heart transplants), and recurrent myocarditis (n=2). This occurred more frequently among patients with midwall LGE (32% vs 11%, p=0.03). Event-free survival was lower among patients with midwall LGE (Figure 1) with a nearly threefold increased hazard of adverse outcome (HR 2.9, 95% CI 1.0-8.4, p=0.047). Conclusion In pediatric CMR-confirmed myocarditis, midwall LGE on early CMR is associated with an increased risk of adverse outcomes. Initial CMR findings may provide prognostic value and aid risk stratification.
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Dennee et al. (2026) conducted a cohort in Pediatric acute myocarditis (n=81). Midwall late gadolinium enhancement (LGE) on early CMR vs. Absence of midwall LGE on early CMR was evaluated on Composite of diagnosis of dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM), or recurrent myocarditis (HR 2.9, 95% CI 1.0-8.4, p=0.047). Midwall LGE on early CMR in pediatric myocarditis was associated with an increased hazard of adverse cardiac outcomes vs no midwall LGE (32% vs 11%; HR 2.9, 95% CI 1.0-8.4, p=0.047).
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