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Myocarditis diagnosis by CMR: what can confuse initial diagnosis?
Session:
CO 20 - Imagem na IC e Doença Coronária
Speaker:
Isabel Cruz
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Isabel Martins Da Cruz; Ana Neto; Inês Oliveira; Bruno Bragança; Rui Pontes Dos Santos; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong><strong> </strong><span style="color:black">Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a “working diagnosis” with multiple underlying aetiologies and pathogenic mechanisms. Failure to identify the underlying cause may result in inappropriate therapy in these patients. Acute myocarditis is a commonly-encountered cause of myocardial injury and is the most common finding in cardiac magnetic ressonance (CMR) imaging studies.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Purpose:</span></strong><strong> </strong><span style="color:black">Characterize a cohort of pts with myocarditis confirmed by CMR and identify clinically relevant features that led to different presumptive diagnostics.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods: </span></strong><span style="color:black">Unicentric, retrospective analysis of pts with myocarditis diagnosis who underwent CMR between 1/2013 and 9/2019. Clinical, analytical, ECG, imagiological features and follow-up (FUP) - cardiovascular (CV) events (CVE) and mortality - were analysed. Pts were divided according to presumptive diagnosis before CMR: myocarditis (G1), MINOCA (G2) or other (G3).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">Out of the 781 CMR studies evaluated 88 pts had (previous history of or acute) myocarditis (11.3%). 57 pts were female (64.8%); mean age 37.7±14.7 years (y). Time to CMR was 1.7±9 months. Regarding CMR data: mean ejection fraction was 58.4±8.4%, mean LV mass was 68.8±14.1grams. 4pts (4.6%) had wall motion abnormalities (WMA) and 80pts (93.0%) had late gadolinium enhancement (LGE). As for affected walls, the most affected was lateral wall (57pts, 59.8%). The majority of pts presented with ST segment elevation (47pts; 53.4%). According to the initial presumptive diagnosis: G1 had 49 pts (55.7%), G2 had 37 pts (42.0%) and G3 had 2 pts (2.3%). We excluded G3 for the subsequent analysis. G2 pts were older (44.1±14.6y vs G1 32.2±12.8y, p<0.001). There were no differences concerning time to CMR, LGE and pericardic effusion presence, neither regarding cardiovascular risk factors. G2 had higher presentation with T wave inversion (p=0.031) and presence of WMA evaluated by echo at admission (p=0.089). G1 had higher c-reactive protein (CRP) maximum values during hospitalization (77.6±64mg/dL vs G2 49.4±48.8, p=0.029). G2 had more CV events at FUP (G1 2.0 vs G2 16.2%, p=0.017).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion:</span></strong><strong> </strong><span style="color:black">In our cohort, 56% of pts were correctly diagnosed from the beginning. They were younger, had higher CRP values and presented less frequently with WMA on initial echo evaluation. G2 pts had more CV events at FUP. Notwithstanding, there were no significant differences regarding CMR features, cardiovascular risk factors nor mortality.</span></span></span></p>
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