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Predictors of the presence of septal late gadolinium enhancement in follow-up cardiac magnetic resonance imaging and its relation to acute myocarditis prognosis
Session:
Posters - B. Imaging
Speaker:
Mariana Martinho
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Posters
FP Number:
---
Authors:
Mariana Martinho; Inês Cruz; Rita Calé; Ana Rita Pereira; Ana I. Marques; Ana Rita Almeida; Luís Lopes; Cristina Lourenço; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Acute Myocarditis (AM) is usually a benign disease but a minority of patients (pts) develop adverse outcomes. Septal late gadolinium enhancement (S-LGE) is associated with worse prognosis and LGE without oedema in follow-up (FUP) cardiac magnetic resonance imaging (CMR) seems to reflect more permanent lesions. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: Determine if S-LGE in acute-phase CMR is associated with worse findings in FUP-CMR and if initial laboratory tests help to predict the evolution to permanent lesions. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Prospective single-centre study of AM pts, diagnosed according to clinical findings, high-sensitivity troponin T (hs-Tn) elevation and CMR criteria (Lake Louise), since 1/2013. Selection of those who underwent acute-phase (CMR-I) and FUP CMR (CMR-II). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Of 88 AM pts, 46 fulfilled our inclusion criteria: median age 31<span style="background-color:white"><span style="color:black">±13 years, 85% males. CMR-I was performed at 6±5days and LGE was present in 43 pts (93.5%). CMR-II was performed at 8±4.3 months and revealed that in 29 pts (63%) LGE-positive segments improved, 10 pts (21.8%) had stable disease and 7 pts (15.2%) worsened CMR findings. S-LGE was detected in 10 pts (21.7%) in CMR-I and in 6pts (13.0%) in CMR-II. Logistic regression analysis identified S-LGE in CMR-I as a predictor of higher extent LGE in CMR-II (OR 1.4, 95%CI 1.1-1.9, p=0.020). Although mean values of maximum hs-Tn and C-reactive protein (CRP) were not associated with S-LGE in CMR-I, they were univariate predictors of a higher likelihood of septal involvement in CMR-II: hs Tn (886 vs 1852ng/L; OR 1.00, 95%CI 1.00-1.00 p=0.017) and CRP (4.2 vs 13.9mg/dL; OR 1.17, 95%CI 1.04-1.33, p=0.012). After multivariate analysis, CRP was the independent predictor of S-LGE in CMR-II (AUC 80.8, 0.97-0.91, p=0.012) and a value >10.2mg/dL showed a sensitivity and specificity of 83.3% and 85.0%, respectively (figure 1). Cardiovascular risk factors, clinical presentation and B-type natriuretic peptide were not predictors of S-LGE in either CMR. In a mean clinical FUP of 757±476days, no patient died, 3 pts (6.5%) developed new-onset heart failure (NYHA class II) and 2 pts (4.3%) ventricular arrhythmias. Due to a small number of adverse events, neither laboratory tests nor S-LGE predicted adverse outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Conclusions</span></span></strong><span style="background-color:white"><span style="color:black">: S-LGE pattern was able to predict higher extent of LGE in FUP-CMR. Increased cardiac biomarkers and inflammatory proteins in acute setting were associated with septal involvement in FUP and can potentially predict the risk of adverse events. </span></span></span></span></p>
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