Among 575 suspected myocarditis cases, 70.8% were confirmed mainly by CMR, with only 5% undergoing biopsy; 34% of confirmed cases had invasive coronary angiography.
In real-world practice, suspected myocarditis is predominantly diagnosed using CMR (84%), with endomyocardial biopsy rarely performed (5%), though invasive coronary angiography is still frequently used (34%) in confirmed cases.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Myocarditis is defined as inflammation of the myocardium, characterized by a variable clinical presentation. The Pre-MYO cohort aims to establish a study platform, with one of its objectives being to evaluate the clinical management of suspected myocarditis. Purpose/Methods The Pre-MYO project is a national, prospective, observational, multicenter registry involving 76 hospitals across all the regions. This project aims to analyze real-world clinical practice in a large cohort of more than 1.000 patients with a clinical suspicion of acute myocarditis or inflammatory cardiomyopathy based on compatible clinical findings. This study examines the clinical management of the first 575 cases included in the cohort. The diagnosis of myocarditis (confirmed, probable and discarded) was obtained through on-site adjudication based on current established diagnostic criteria. Results The study cohort has predominantly male (78.6%) and a mean age of 41.0±18.8 years. A final definitive diagnosis of myocarditis was established in 70.8% of cases. Cardiac magnetic resonance imaging (CMR) was performed in most of patients, 84%, and CMR timing revealed that 17.6% of patients had the exam performed after discharge. Less than half of patients, 44%, had a serology or viral PCR result. Coronary artery disease screening was performed in 56.6% of cases (43.0% invasive coronary angiography, 13.6% coronary CT). Invasive coronary angiography was performed in 34% of patients with final diagnosis of confirmed myocarditis (2, (1.4%, had significant lesions) and 68% of patients without myocarditis (12, 15%, had significant lesions). Endomyocardial biopsy was performed in only 29 cases (5%), confirming myocarditis in 25 (6.1% of confirmed cases) and PET-CT was used in 20 cases (3.5%). Among the 168 patients who diagnosis of myocarditis was not confirmed, 51 (8.9%) were classified as probable myocarditis, while 117 (20.3%) received alternative diagnoses. Among alternative diagnoses, the most common being MINOCA (24.8%), pericarditis (13.7%), heart failure (12.0%), undefined cardiac diagnosis (12.0%), coronary syndrome (10.2%), Takotsubo (7.7%), arrhythmias (6.8%), and cardiomyopathy (6.0%). The hospital stay had a median of 5 days (IQR: 3–8): 5 days (IQR: 3–7) for confirmed myocarditis, 4 days (IQR: 3–6) for probable myocarditis, and 6 days (IQR: 3–10) for cases without final diagnosis of myocarditis (p=0.056). Conclusions Among patients with suspicion of myocarditis, 78.6% of cases had a final diagnosis mainly based on CMR, with endomiocardial biopsy restricted to a low number (5%) of cases. However, 34% of patients with final diagnosis of myocarditis underwent invasive coronary angiography, which highlights the need for diagnostic tools able to improve accuracy by ruling-out coronary artery disease.
Rodriguez et al. (Sat,) reported a other. Among 575 suspected myocarditis cases, 70.8% were confirmed mainly by CMR, with only 5% undergoing biopsy; 34% of confirmed cases had invasive coronary angiography.