Atrial Function by Long Axis Shortening Enhances Risk Stratification Beyond Traditional CMR Markers in Possible Myocarditis

Ciocca, N; Brändle, D; Riederer, L; Fischer, K; Schütze, J; Wahl, A; Tanner, G; Guensch, DP; Stoyanov, K; Garefa, C; Pavlicek-Bahlo, M; Hundertmark, M; Shiri, I; Bernhard, B; Kwong, RY; Gräni, C

doi:10.1016/j.jcmg.2026.04.006

Heart failure & cardiomyopathies

Atrial Function by Long Axis Shortening Enhances Risk Stratification Beyond Traditional Cardiac Magnetic Resonance (CMR) Markers in Possible Myocarditis

JACC Cardiovasc ImagingPublished 27 May 2026Cohort study

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Authors' conclusion

Atrial dysfunction can be present in possible myocarditis and atrial LAS was independently and incrementally associated with outcomes beyond traditional CMR markers and may refine future risk stratification in this clinical setting.

Study context

Population: Patients meeting 2025 ESC criteria for possible myocarditis undergoing CMR, without CAD or alternative diagnosis
Participants: 787 patients

Exposure: Atrial long axis shortening (LAS) as predictor of MACE
Outcome: First MACE:
HF hospitalization
Sustained VT
Recurrent myocarditis
All-cause mortality
Follow-up: Median 3.5 years (Q1-Q3: 1.8-6.5 years)

Methodological details2 tertiary centres

2 tertiary centres

Main finding

As reported in the abstract

MACE

Multivariable

Hazard ratio (95% CI)P value

LA-LAS below median (22%)

2.17(1.33–3.57)

P = 0.002

RA-LAS below median (29%)

1.75(1.12–2.70)

P = 0.012

Experienced MACE: 17.5%
LA-LAS (mean ± SD): 21.5% ± 10.1%
RA-LAS (mean ± SD): 29.5% ± 12.1%

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
MACE, univariate (per 5% decrease)LA-LAS (per 5% decrease) · univariate	0.512	1.37 (1.23–1.52)	P < 0.001
MACE, univariate (per 5% decrease)RA-LAS · univariate	0.512	1.27 (1.19–1.37)	P < 0.001
	0.512Hazard ratio (log scale)

Incremental risk stratification (adding LA-LAS and RA-LAS to clinical variables, LV end-diastolic volume, left ventricular ejection fraction (LVEF), late gadolinium enhancement (LGE))

Chi-square increase: 11.3
P: P < 0.001
C-index: from 0.72 to 0.75

Original publication

Atrial Function by Long Axis Shortening Enhances Risk Stratification Beyond Traditional CMR Markers in Possible Myocarditis. JACC Cardiovasc Imaging. Published 27 May 2026. doi:10.1016/j.jcmg.2026.04.006

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