Heart failure & cardiomyopathies
Multiparametric Cardiac Magnetic Resonance Imaging to Discriminate Endomyocardial Biopsy-Proven Chronic Myocarditis From Healed Myocarditis
Authors' conclusion
A multiparametric CMR protocol allows detection of ongoing myocardial inflammation and discrimination of chronic myocarditis from healed myocarditis, with segmental T2 mapping and biventricular strain analysis showing higher diagnostic accuracy compared with T1 mapping, extracellular volume fraction, and LGE.
Study context
- Population
- Patients with persistent symptoms (>30 days) suggestive of myocarditis; biopsy-proven chronic lymphocytic myocarditis (53) or healed myocarditis (50)of 452 consecutive patients
- Participants
- 103 patients
- Comparison
- Multiparametric cardiac magnetic resonance (CMR) parameters vs endomyocardial biopsy
- Outcome
- Detection of ongoing inflammation and discrimination of chronic from healed myocarditis (endomyocardial biopsy reference)
Methodological detailsprospective, single-centre, consecutive patients
- Prospective
- Single-centre
- Consecutive patients
Performance
As reported in the abstract
Discrimination of chronic from healed myocarditis
| Test or model | AUC | Accuracy (≥3 segments) |
|---|---|---|
| T2 mapping | 0.87 [95% CI: 0.79-0.93]; P < 0.001 | 92%; 95% CI: 85-97 |
| LV radial peak systolic strain rate | 0.86 | Not reported in the abstract |
| RV radial peak systolic strain rate | 0.84 | Not reported in the abstract |
| T1 mapping | 0.64 | Not reported in the abstract |
| Extracellular volume fraction | 0.62 | Not reported in the abstract |
| Late gadolinium enhancement (LGE) | 0.57 | Not reported in the abstract |
AUC
T2 mapping0.87 [95% CI: 0.79-0.93]; P < 0.001
LV radial peak systolic strain rate0.86
RV radial peak systolic strain rate0.84
T1 mapping0.64
Extracellular volume fraction0.62
Late gadolinium enhancement (LGE)0.57
Accuracy (≥3 segments)
T2 mapping92%; 95% CI: 85-97
LV radial peak systolic strain rateNot reported in the abstract
RV radial peak systolic strain rateNot reported in the abstract
T1 mappingNot reported in the abstract
Extracellular volume fractionNot reported in the abstract
Late gadolinium enhancement (LGE)Not reported in the abstract
Further findings
- Specificity increased when T2 mapping was combined with elevation of either troponin or C-reactive protein
Original publication
Multiparametric Cardiac Magnetic Resonance Imaging to Discriminate Endomyocardial Biopsy-Proven Chronic Myocarditis From Healed Myocarditis. JACC Cardiovasc Imaging. Published 7 August 2024. doi:10.
Summarised from the published abstract; every number is checked against it