Late gadolinium enhancement quantification by the full width at half maximum (FWHM) method was significantly associated with major adverse cardiac events (HR 1.05) and demonstrated the highest reproducibility.
Observational (n=670)
No
Does LGE quantification by FWHM or visual scoring improve risk stratification for MACE compared to SD-based methods in patients with suspected myocarditis?
FWHM and visual presence scoring are the optimal methods for quantifying late gadolinium enhancement to risk-stratify patients with suspected myocarditis, outperforming standard deviation-based thresholds.
Hazard Ratio: 1.05 (95% CI 1.02–1.08)
p-value: p=0.001
BACKGROUND: Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. METHODS: Six hundred seventy consecutive patients (48 ± 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods. RESULTS: Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio HR 1.05, 95% confidence interval CI:1.02-1.08, p = 0.001; HR 1.02, 95%CI:1.00-1.04; p = 0.001; HR 1.02, 95%CI: 1.00-1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04-1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values. CONCLUSIONS: FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients. TRIAL REGISTRATION NUMBER: NCT03470571 . Registered 13th March 2018. Retrospectively registered.
Gräni et al. (Tue,) conducted a observational in Suspected myocarditis (n=670). Late gadolinium enhancement (LGE) quantification by full width at half maximum (FWHM) vs. Other LGE quantification methods (2-SD to 7-SD) was evaluated on Major adverse cardiac events (MACE: all-cause death, heart failure decompensation requiring hospital admission, heart transplantation, documented sustained ventricular arrhythmia, recurrent acute myocarditis) (HR 1.05, 95% CI 1.02-1.08, p=0.001). Late gadolinium enhancement quantification by the full width at half maximum (FWHM) method was significantly associated with major adverse cardiac events (HR 1.05) and demonstrated the highest reproducibility.