Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis

• Published in: Journal of cardiovascular magnetic resonance Vol. 16; no. 1; p. 14
• Main Authors: Schumm, Julia, Greulich, Simon, Wagner, Anja, Grün, Stefan, Ong, Peter, Bentz, Kerstin, Klingel, Karin, Kandolf, Reinhard, Bruder, Oliver, Schneider, Steffen, Sechtem, Udo, Mahrholdt, Heiko
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.01.2014; BioMed Central
• Subjects: Adult; Aged; Cardiology; Cardiovascular disease; Chi-Square Distribution; Death; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators; Defibrillators, Implantable; Diagnosis; Electric Countershock - instrumentation; Health aspects; Heart attacks; Heart failure; Hospitalization; Humans; Kaplan-Meier Estimate; Magnetic resonance; Magnetic Resonance Imaging, Cine; Male; Medical prognosis; Medical records; Middle Aged; Mortality; Multivariate Analysis; Myocarditis - complications; Myocarditis - diagnosis; Myocarditis - mortality; Myocarditis - physiopathology; Myocarditis - therapy; Patients; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Rankings; Risk; Risk Assessment; Risk Factors; Stratification; Stroke Volume; Studies; Time Factors; Ventricular Function, Left
• ISSN: 1097-6647; 1532-429X; 1532-429X
• DOI: 10.1186/1532-429X-16-14

The diagnosis of myocarditis is challenging due to its varying clinical presentation. Since myocarditis can be associated with significant 5-year mortality, and postmortem data show myocarditis in almost 10% of all adults suffering sudden cardiac death, individual risk stratification for patients with suspected myocarditis is of great clinical interest. We sought to demonstrate that patients with clinically suspected myocarditis and a normal cardiovascular magnetic resonance (CMR) according to our definition have a good prognosis, independent of their clinical symptoms and other findings. Prospective clinical long-term follow-up of consecutive patients undergoing CMR for work-up of clinically suspected myocarditis at our institution in 2007-2008. Follow-up was available for n=405 patients (all-comers, 54.8% inpatients, 38% outpatient referrals from cardiologists). Median follow-up time was 1591 days. CMR diagnosis was "myocarditis" in 28.8%, "normal" in 55.6% and "other pathology" in 15.6%. Normal CMR was defined as normal left ventricular (LV) volumes and normal left ventricular ejection fraction (LV-EF) in the absence of late Gadolinium Enhancement (LGE). The overall mortality was 3.2%. There were seven cardiac deaths during follow-up, in addition one aborted SCD and two patients had appropriate internal cardioverter defibrillator (ICD) shocks - all of these occurred in patients with abnormal CMR. Kaplan-Meier analysis with log-rank test showed significant difference for major adverse cardiac events (cardiac death, sudden cardiac death (SCD), ICD discharge, aborted SCD) between patients with normal and abnormal CMR (p=0.0003). In our unselected population of consecutive patients referred for CMR work-up of clinically suspected myocarditis, patients with normal CMR have a good prognosis independent of their clinical symptoms and other findings.