In acute myocarditis correlation between EKG abnormalities and late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) isn’t well defined.
The aim of this study is to describe prevalence and type of EKG abnormalities and to evaluate their correlation with LGE distribution.
29 patients were admitted for suspected acute myocarditis in last two years in our institution. All patients had non-significant coronary artery disease at coronary angiography. We evaluated 12-lead EKG at admission and performed a 3T-CMR before discharge which included T2-map and LGE sequences.
21 patients had abnormal EKG upon admission (72%). The most common abnormality was ST-segment elevation (81%), followed by bundle-branch-block (24%) and Q-waves (19%).
In patients with anterior or septal LGE, ST-elevation was more frequently observed in anterior leads (60%), whereas in patients with lateral or inferior LGE its prevalent location was in the inferolateral leads (50%). (Fig.1)
In patients with diffuse ‘patchy’ LGE there wasn’t a specific EKG pattern.
Bundle-branch-block occurred more often in patients with antero-septal LGE (40% vs 15% in the infero-lateral LGE).
Patients with Q-waves were equally distributed between groups and the presence of Q waves was usually correlated with more extensive transmural LGE.
EKG abnormalities can be found in most patients with acute myocarditis at presentation, but a normal EKG can’t exclude the diagnosis, which is now strongly based on CMR findings. However, the good correlation between LGE localization and EKG abnormalities confirms the important clinical role of EKG in the evaluation of these patients.