Heart failure & cardiomyopathies

Clinical and cardiac magnetic resonance phenotype of probable viral vs probable immune-mediated acute myocarditis

Eur J Heart FailPublished Cohort study

An erratum to this article was published (Eur J Heart Fail, 10 Sep 2026 ↗)

Main finding · Composite endpointResult — go to the resultAdjusted hazard ratio 1.89 95% CI 1.03–3.48

Authors' conclusion

pVM and pIM were associated with distinct clinical and CMR phenotypes.

Study context

Population
Patients referred for cardiac magnetic resonance (CMR) for clinically suspected myocarditisreferred for CMR
Participants
1,122 patients
Exposure
Probable immune-mediated vs probable viral acute myocarditis
  • Probable viral myocarditis (pVM)n = 379reference
  • pIMn = 116
Outcome
Composite of:
  • First HF hospitalization
  • Recurrent myocarditis
  • Sustained VT
  • All-cause death
Follow-up
Median 3.3 years
Methodological detailstwo tertiary centres
  • Two tertiary centres

Main finding

Composite endpoint

Adjusted hazard ratio

1.89

95% CI 1.03–3.48

P = 0.041

pIMvs pVM
HRadj 1.89 (95% CI 1.03–3.48); P = 0.041

As reported in the abstract

Observational data: associations, not effects.

Further findings

Age

P < 0.001

Acute chest pain and ST-segment elevation

P = 0.012

Late gadolinium enhancement

P = 0.006

Basal septal LGE involvement

P = 0.006

Predictors of adverse events (within groups)

In pIM, age was the only predictor of adverse events; in pVM multiple clinical and CMR features were prognostically relevant

Original publication

Clinical and cardiac magnetic resonance phenotype of probable viral vs probable immune-mediated acute myocarditis. Eur J Heart Fail. Published 18 June 2026. doi:10.1093/ejhf/xuag202

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