Comparing the findings and diagnostic sensitivity of cardiovascular magnetic resonance in biopsy confirmed acute myocarditis with infarct-like vs. heart failure presentation

• Published in: Journal of cardiovascular magnetic resonance 2022-12, Vol.24 (1), p.69-69, Article 69
• Main Authors: Hassan, Karim, Doubell, Anton, Kyriakakis, Charles, Joubert, Lloyd, Robbertse, Pieter-Paul, Van Zyl, Gert, Zaharie, Dan, Herbst, Philip
• Format: Article
• Language: English
• Subjects: Biopsy; Cardiac magnetic resonance imaging; Cardiology; Cardiovascular disease; Chest; Chest pain; Congestive heart failure; Contrast Media; Coronary vessels; Coronaviruses; Cross-Sectional Studies; Cytomegalovirus; Diagnosis; Diagnostic imaging; Diagnostic systems; Dyspnea; Edema; EKG; Electrocardiogram; Electrocardiography; Fractions; Gadolinium; Heart diseases; Heart failure; Heart Failure - diagnostic imaging; Humans; Laboratories; Lake Louise criteria; Magnetic resonance; Magnetic Resonance Spectroscopy; Mapping; Medical imaging; Medical research; Medicine, Experimental; Musculoskeletal system; Myocarditis; Pain; Parametric mapping; Predictive Value of Tests; Resonance; Retrospective Studies; Segments; Sensitivity; Signs and symptoms; Society; Statistical analysis; Vein & artery diseases; Ventricle; Viral myocarditis
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-022-00903-y

Cardiovascular magnetic resonance (CMR) is considered the reference imaging modality in providing a non-invasive diagnosis of acute myocarditis (AM), as it allows for the detection of myocardial injury associated with AM. However, the diagnostic sensitivity and pattern of CMR findings appear to differ according to clinical presentation. This is a retrospective cross-sectional study. Consecutive adult patients presenting to a single tertiary centre in South Africa between August 2017 and January 2022 with AM confirmed on endomyocardial biopsy (EMB) were enrolled. Patients with infarct-like symptoms, defined as those presenting primarily with chest pain syndrome with associated ST-T wave changes on electrocardiogram, or heart failure (HF) symptoms, defined as clinical signs and symptoms of HF without significant chest discomfort, were compared using contrasted CMR and parametric techniques with EMB confirmation of AM as diagnostic gold standard. Forty-one patients were identified including 23 (56%) with infarct-like symptoms and 18 (44%) with HF symptoms. On CMR, the infarct-like group had significantly higher ejection fractions of both ventricles (LVEF 55.3 ± 15.3% vs. 34.4 ± 13.5%, p