What is the clinical evidence from this study?

Study design: Cohort. Population: Acute clinically suspected myocarditis (n=133). Intervention: Cardiac MRI parameters (LVGLS, LVEF, LVEDVI). Primary outcome: Major adverse cardiovascular events (MACE) (OR 0.760, 95% CI 0.655-0.882, p=<0.001).

What does this research mean for the field?

In patients with acute myocarditis, left ventricular ejection fraction and global longitudinal strain are strong predictors of major adverse cardiovascular events, with each 1% decrease in global longitudinal strain associated with a 24% increase in event incidence. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 7, 2022Frontiers in Cardiovascular Medicine5 citationsOpen Access

The crucial role of cardiac MRI parameters in the prediction of outcomes in acute clinically suspected myocarditis: A functional and feature-tracking study

Q: What are the key findings of this study?

In patients with acute myocarditis, each 1% decrease in left ventricular global longitudinal strain (LVGLS) was associated with a 24% increase in the incidence of major adverse cardiovascular events.

Q: What does this research mean for the field?

In patients with acute myocarditis, left ventricular ejection fraction and global longitudinal strain are strong predictors of major adverse cardiovascular events, with each 1% decrease in global longitudinal strain associated with a 24% increase in event incidence. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

MMMarzieh Motevalli SASanaz Asadian FKForoogh Khademi

Key Result

In patients with acute myocarditis, each 1% decrease in left ventricular global longitudinal strain (LVGLS) was associated with a 24% increase in the incidence of major adverse cardiovascular events.

Study Design

Type

Cohort (n=133)

Structured PICO

Do functional and feature-tracking-derived cardiac MRI parameters predict major adverse cardiovascular events in patients with acute myocarditis?

Population

133 patients with acute clinically suspected myocarditis (mean age 36.5, 74.4% male). Key inclusion criteria: history of acute symptoms within a few days before admission, increased troponin levels, normal coronary angiography or CT angiography, and CMR images with evidence of myocardial edema as well as mid-wall and subepicardial late gadolinium enhancement (LGE).

Intervention

Cardiac magnetic resonance (CMR) imaging with functional and feature-tracking (FT)-derived strain evaluation (specifically assessing LVEF, LVEDVI, and LV global longitudinal strain [LVGLS]).

Outcome

Major adverse cardiovascular events (MACE), defined as the incidence of cardiac death, implantable cardioverter-defibrillator (ICD) implantation, or heart transplantation, assessed over a mean follow-up of 31 ± 16 months.composite

In patients with acute myocarditis, cardiac MRI-derived LVEF, LVEDVI, and LV global longitudinal strain (LVGLS) are strong independent predictors of major adverse cardiovascular events.

Main Result

Effect estimate: OR 0.760 (95% CI 0.655-0.882)

p-value: p=<0.001

Limitations

Retrospective design with limited data regarding patient history and risk profile
Lack of follow-up information in a minority of patients
Lack of imaging data for novel mapping methods
Potential referral bias leading to a relatively higher incidence of MACE
Interobserver variability was not reported
Included only patients with acute myocarditis
Lack of access to prognosis in a minority of patients, reducing the sample size
Lack of imaging data in a significant number of patients precluded employing novel mapping methods
Referral bias leading to a relatively higher incidence of MACE (low-risk young patients often do not get referred for CMR)
Retrospective design limited access to patient history and risk profiles
Lack of interobserver variability reporting for functional measurements
Included only patients with acute myocarditis, limiting generalizability to other myocarditis categories

Abstract

Background: The definitive diagnosis of myocarditis is made by endomyocardial biopsy, but it is an invasive method. Recent investigations have proposed that cardiac MRI parameters have both diagnostic and prognostic roles in assessing myocarditis. We aimed to evaluate the role of functional and feature-tracking (FT)-derived strain values in predicting major adverse cardiovascular events (MACE) in patients with acute myocarditis. Methods and results: We evaluated 133 patients with acute myocarditis (74.4% men) between January 2016 and February 2021. During a mean follow-up of 31 ± 16 months, sixteen patients (12.03%) experienced MACE: three deaths (2.3%), nine ICD implantations (6.76%), and five cardiac transplantations (3.8%). The left ventricular ejection fraction (LVEF), the LV end-diastolic volume index (EDVI), and the LV global longitudinal strain (GLS) were the strongest predictors of MACE. Each 1-unit decline in LVEF and LVGLS or 1-unit rise in LVEDVI resulted in a 5, 24, and 2% increase in MACE, respectively. LVEF ≤36.46% and LVGLS ≤9% indicated MACE with 75% sensitivity and 74.4 and 73.5% specificity, respectively. Conclusions: In a group of acute myocarditis patients with evidence of myocardial edema and late Gadolinium enhancement, LVEF and GLS were the strongest predictors of adverse cardiac events.

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