Riccardo Faletti1, Marco Gatti2, Ilaria Baralis1, Laura Bergamasco3, Rodolfo Bonamini3, Francesca Ferroni4, Massimo Imazio5, Silvia Stola1, Fiorenzo Gaita5, Paolo Fonio1. 1. Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy. 2. Department of Surgical Sciences, Radiology Institute, University of Turin, Via Genova 3, 10126, Turin, Italy. marcogatti17@gmail.com. 3. Department of Surgical Sciences, University of Turin, Turin, Italy. 4. Division of Pediatric Cardiology, Citta' della Salute e della Scienza, Turin, Italy. 5. University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Turin, Italy.
Abstract
AIMS: To analyse the clinical and magnetic resonance evolution of myocarditis in patients with an "infarct-like" presentation pattern. METHODS: The study is a retrospective analysis of 52 patients with clinical diagnosis of "infarct-like" myocarditis confirmed by CMR as acute myocarditis according to Lake Louise criteria and 6 months follow-up. The CMR protocol included T2-weighted (oedema), early (hyperaemia) and late (fibrosis/necrosis) gadolinium enhancement sequences, according to Lake Louise criteria. Clinical and radiological follow-up by CMR was performed after a median time interval of 6 months (interquartile range 5-8). Quantitative outcomes were checked for normality and compared with the non-parametric Wilcoxon's test for matched data. RESULTS: At the clinical follow-up all patients were free of symptoms and reported no cardiac complications. The CMR follow-up evidenced a significant increase of the ejection fraction (from 53 ± 6 to 55 ± 4%, p = 0.03), a decrease of the ventricular mass [from 67.0 (58.8-79.0) to 61.0 (54.0-67.0), p < 0.0001] without significant modification of the cardiac volume index (p = 0.26). No patient had residual oedema or capillary leakage: the T2 ratio decreased from 3.94 (3.00-4.86) to 0.98 (0.75-1.17) with p < 0.0001 and the Early gadolinium enhancement (EGE) ratio from 5.7 (4.8-6.5) to 2.9 (2.4-3.2) with p < 0.0001. Late gadolinium enhancement (LGE) persisted over the course of the follow-up in 48/52 patients, but with a significant reduction in every patient (LGE % from 34.3 ± 9.1 to 19.4 ± 6.6%; p < 0.0001). CONCLUSION: Patients diagnosed with "infarct-like" myocarditis, according to both clinical and CMR examinations may look forward to a positive evolution with a good prognosis.
AIMS: To analyse the clinical and magnetic resonance evolution of myocarditis in patients with an "infarct-like" presentation pattern. METHODS: The study is a retrospective analysis of 52 patients with clinical diagnosis of "infarct-like" myocarditis confirmed by CMR as acute myocarditis according to Lake Louise criteria and 6 months follow-up. The CMR protocol included T2-weighted (oedema), early (hyperaemia) and late (fibrosis/necrosis) gadolinium enhancement sequences, according to Lake Louise criteria. Clinical and radiological follow-up by CMR was performed after a median time interval of 6 months (interquartile range 5-8). Quantitative outcomes were checked for normality and compared with the non-parametric Wilcoxon's test for matched data. RESULTS: At the clinical follow-up all patients were free of symptoms and reported no cardiac complications. The CMR follow-up evidenced a significant increase of the ejection fraction (from 53 ± 6 to 55 ± 4%, p = 0.03), a decrease of the ventricular mass [from 67.0 (58.8-79.0) to 61.0 (54.0-67.0), p < 0.0001] without significant modification of the cardiac volume index (p = 0.26). No patient had residual oedema or capillary leakage: the T2 ratio decreased from 3.94 (3.00-4.86) to 0.98 (0.75-1.17) with p < 0.0001 and the Early gadolinium enhancement (EGE) ratio from 5.7 (4.8-6.5) to 2.9 (2.4-3.2) with p < 0.0001. Late gadolinium enhancement (LGE) persisted over the course of the follow-up in 48/52 patients, but with a significant reduction in every patient (LGE % from 34.3 ± 9.1 to 19.4 ± 6.6%; p < 0.0001). CONCLUSION:Patients diagnosed with "infarct-like" myocarditis, according to both clinical and CMR examinations may look forward to a positive evolution with a good prognosis.
Entities:
Keywords:
Acute myocarditis; Cardiovascular magnetic resonance; Outcome; “Infarct-like” myocarditis
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