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Heart failure & cardiomyopathiesCohort study

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

JACC Cardiovasc ImagingPublished

  • Cohort study
  • 2 tertiary centres
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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)

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

OutcomeHR (95% CI)P value
MACE, univariate (per 5% decrease) — LA-LAS (per 5% decrease) · univariate1.37 (1.23–1.52)P < 0.001
MACE, univariate (per 5% decrease) — RA-LAS · univariate1.27 (1.19–1.37)P < 0.001

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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Summarised from the published abstract; every number is checked against it