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Diagnostic applications of cardiac magnetic resonance with T1/2 tissue mapping in acute myocarditis patients at a London tertiary centre

Session Poster session 2

Speaker Lucie Pearce

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Myocardium
  • Session type : Poster Session

Authors : L Pearce (London,GB), L Dancy (London,GB), K Le (London,GB), D Bromage (London,GB), A Nabeebaccus (London,GB), J Harrison (London,GB), D Sado (London,GB)

Authors:
L Pearce1 , L Dancy1 , K Le1 , D Bromage1 , A Nabeebaccus1 , J Harrison1 , D Sado1 , 1Kings College Hospital - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii368

INTRODUCTION

Myocarditis is an important cause of heart failure and hospitalisation in young adults. In recent years cardiac magnetic resonance (CMR) has been an important modality for diagnosis in the acute setting. The ‘Lake-Louise’ criteria requires at least 2 of 3 conditions to be met for diagnosis including abnormal myocardial T2, high global early enhancement ratio compared to skeletal muscle and  non -ischaemic late gadolinium enhancement (LGE). However, using this criteria, some cases will be missed. We believe that some such cases are those with more mild, diffuse disease. In this study, we aim to investigate a potential role for parametric tissue mapping with T1 and T2 to aid in making a diagnosis of myocarditis.

METHODS

All patients undergoing inpatient CMR between October 2016-2018 were screened retrospectively (n= 438). Patients with a diagnosis of acute myocarditis were identified from CMR reports (n=70). Data was collected from reports and the radiology database regarding tissue (T1/2) weighted mapping and late gadolinium enhancement (LGE). Information on all-cause mortality at 60 days and major adverse cardiovascular events (MACE) was obtained. Data was also obtained regarding peak troponin and CMR ejection fraction (EF).

RESULTS

N=70 patients were diagnosed with acute myocarditis during the period as a single or dual pathology (90% and 10% respectively). Median age was 45 years (17-88 years). Median peak troponin I (CTnI) value was 1679 (<6 to >50,000).

1 patient did not undergo tissue mapping during the period. In 4 patients LGE was not performed. In all other patients, the image quality obtained was of diagnostic quality. T1/T2 weighted tissue mapping was abnormal in 97% of patients. LGE was abnormal in 68% of cases. In the remaining 32%, a diagnosis was formed on the basis of abnormal tissue mapping alone. Of these patients, 29% had global myocarditis.

Overall mean CMR EF was preserved at 60% (24-77%). EF was not significantly reduced in those with global involvement compared to those without (56% vs. 61%, p=0.7).

At 60 days, all -cause mortality was 1% and MACE 6% (Fig.1). In one patient, it became apparent that we had made an incorrect diagnosis of myocarditis and the patient in fact had multiple small embolic infarcts – she subsequently re-presented with aborted sudden death with an inferior STEMI on what was a previously non obstructive plaque.

CONCLUSIONS

In this retrospective analysis of acute myocarditis patients, myocardial tissue mapping (T1/2) was abnormal in 97% of patients, including in the 32% patients where no LGE was otherwise seen. A significant proportion of such patients had global involvement which can be difficult to diagnose using conventional non parametric sequences and may partly explain why CMR has "missed" some cases of myocarditis in previous studies. Overall mortality and MACE at 60-days is low amongst acute myocarditis patients who survive to undergo CMR imaging.

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