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Do ECG changes on admission predict acute myocardial lesion and fibrosis on acute myocarditis?
Session:
CO 13 - Miocárdio e Pericárdio
Speaker:
Daniel Seabra De Carvalho
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Seabra De Carvalho; Leonor Marques; Ana Leal Neto; Henrique Guedes; João A. G. Azevedo; Paula Pinto
Abstract
<p><strong>Introduction: </strong>Electrocardiogram (EGG) is usually abnormal in acute myocarditis. Although not sensitive or specific, concave and diffuse ST segment elevation is associated with this diagnosis. Previous studies have shown that electrocardiographic changes have prognostic impact. However their role in myocardial lesion prediction and late gadolinium enhancement (LGE) development is uncertain.</p> <p><strong>Aims: </strong>Evaluate the presence of ECG alterations in a cohort of patients (pts) with clinical and/or imagiological diagnosis of myocarditis, and evaluate its association with serum biomarkers of myocardial damage and with fibrosis evidence on cardiac magnetic ressonance (CMR).</p> <p><strong>Methods: </strong>We retrospectively analysed a cohort of pts with clinically diagnosis of acute myocarditis that were submitted to CMR between 1/2013 and 9/2017. Two subgroups were identified: group A (GA), with electrical changes (ST segment elevation, T wave inversion), and group B (GB), without electrical changes. Clinical characteristics (age, sex), inflammatory [leukocytosis, c reactive protein (CRP)] and cardiac biomarkers [troponin I (TnI), creatine phosphokinase (CPK), myoglobin, brain natriuretic peptide (BNP)], echocardiographic [wall motion abnormalities (WMA), left ventricle ejection fraction (LVEF)] and CMR parameters [LVEF, late gadolinium enhancement (LGE)] were evaluated and compared between groups.</p> <p><strong>Results: </strong>60 pts were included (75% male; mean age 38.0±12.8 years) and, when comparing GA with GB, we found that GA consisted in 40 pts, with higher prevalence of male gender (83 vs 17%, p=0.05), with no difference in mean age. GA presented higher peak value of CRP (77.1±58.0 vs 44.1±58 mg/L, p=0.04), TnI (12.5±10.7 vs 4.6±10.6 ng/mL, p=0.006) and CPK (710.3±661.3 vs 354.5±652.9 UI/L, p=0.05). Regarding echocardiographic assessment, GA had lower LVEF (52.7±9.5 vs 60.5±9.3%, p=0.002), with no differences on WMA prevalence. Considering CMR parameters, GA presented with lower LVEF values (57.0±7.0 vs 61.0±6.9%, p=0.032), with no differences in LGE prevalence and its distribution pattern.</p> <p><strong>Conclusions: </strong>In the analysed cohort, we showed that ECG changes were more frequent in males. The presence of ECG abnormalities predicted the extent of acute myocardial lesion, as shown by higher peak plasmatic values of TnI and CRP, but not the development of fibrosis, since there was no difference in LGE prevalence.</p>
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