In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


The free consultation period for this content is over.

It is now only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members

Diagnosing myocardial inflammation in systemic sclerosis and infective myocarditis: are the lake Louise criteria sufficient?

Session Poster session 1

Speaker George Markousis-Mavrogenis

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : T1 and T2 Mapping, T2*
  • Session type : Poster Session
  • FP Number : P175

Authors : G Markousis-Mavrogenis (Athens,GR), L Koutsogeorgopoulou (Athens,GR), D Apostolou (Athens,GR), G Katsifis (Athens,GR), T Dimitroulas (Thessaloniki,GR), P Argyriou (Athens,GR), L Papa (Athens,GR), M Kanoupaki (Athens,GR), E Angelopoulos (Athens,GR), E Vernardos (Athens,GR), G Kanoupakis (Athens,GR), G Kolovou (Athens,GR), S I Mavrogeni (Athens,GR)

Authors:
G Markousis-Mavrogenis1 , L Koutsogeorgopoulou2 , D Apostolou3 , G Katsifis4 , T Dimitroulas5 , P Argyriou3 , L Papa3 , M Kanoupaki3 , E Angelopoulos3 , E Vernardos3 , G Kanoupakis3 , G Kolovou1 , S I Mavrogeni1 , 1Onassis Cardiac Surgery Center - Athens - Greece , 2Laiko University General Hospital, Pathophysiology Department - Athens - Greece , 3Mediterraneo Hospital, Cardiovascular MRI Unit - Athens - Greece , 4Naval Hospital of Athens - Athens - Greece , 5Aristotle University of Thessaloniki, Department of Rheumatology - Thessaloniki - Greece ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii133

Background

The Lake Louise criteria (LLc) are the current diagnostic gold standard for the diagnosis of myocarditis. However, they have been developed with the purpose of diagnosing mainly infective myocarditis.

Purpose

We hypothesized that the LLc would underperform in the detection of myocardial inflammation in autoimmune disease compared to infective myocarditis. We aimed to demonstrate this in a cohort of patients with systemic sclerosis (SSc).

Methods

34 patients with suspected infectious myocarditis, 32 diffuse cutaneous SSc patients with a clinical suspicion of cardiac involvement, as well as 31 healthy controls were evaluated with cardiovascular magnetic resonance imaging (CMR) using a 1.5T scanner. The T2 signal ratio (myocardium/skeletal muscle), early and late gadolinium enhancement (EGE/LGE) as well as parametric indices including native/post-contrast T1-mapping, T2 mapping and extracellular volume fraction (ECV) values were determined for all participants. The LLc were compared with a diagnostic model including parametric indices using locally defined cut-off values (Figure 1).

Results

Both the LLc and our proposed model had complete agreement in healthy controls (0 diagnoses of myocarditis). In patients with suspected infective myocarditis, the models had an observed agreement of 91.2 % (95% CI: 76.3-98.1%) in 31/34 patients and a Cohen’s kappa value of 0.35 (p<0.001). However, McNemar’s test for marginal homogeneity was not significant (p=0.637). In SSc patients, there was only 65.6% (95% CI: 46.81-81.4%) observed agreement in 21/32 patients, Cohen’s kappa was 0.31 (p<0.01) and McNemar’s test was significant (p<0.001).

Conclusions

Both the LLc criteria and our proposed parametric model have good specificity. Although both models have good agreement with regard to infective myocarditis, the LLc miss approximately a third of the cases of myocardial inflammation in SSc patients compared to the proposed parametric model. In patients with SSc and suspected myocarditis, both the LLc and our proposed parametric model should be used in conjunction in order to ensure optimal detection and prompt initiation of immunosuppressive treatment.

The free consultation period for this content is over.

It is now only available year-round to EACVI Silver Members, Fellows of the ESC and Young combined Members



Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are