SPC365

Cardiac Magnetic Resonance in myocarditis: besides the diagnosis?

Session: Posters (Sessão 1 - Écran 7) - Miscelânea - Vários Temas
Speaker: Pedro Rocha Carvalho

Congress: CPC 2022
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Pedro Rocha Carvalho; Jose Monteiro; Catarina Carvalho; Marta Bernardo; Catarina Ferreira; Inês Silveira; Paulo Fontes; Ilidio Moreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Introduction:</span></span></span></span></strong> <span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Patients with acute myocarditis (AM) can be at increased risk of adverse cardiac events after the index episode. Beyond its undoubted role in diagnosis, Cardiac Magnetic Resonance (CMR) can also provide additional prognostic information and contribute to the patients risk stratification. </span></span></span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"><strong><span style="background-color:white">Methods: </span></strong><span style="background-color:white">Retrospective study with patients admitted with the clinical suspicion of myocarditis in our center from February/2018 to September/2021, in whom CMR was performed. A total of 48 p</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">atients were included and divided into two groups based on the number of segments with late gadolinium enhancement (LGE). <span style="color:black">The threshold (&gt; or &lt; than 5 segments) was determined according to ROC curve analysis</span>. <span style="background-color:white"><span style="color:black">The primary outcome was a composite of all-cause mortality, heart failure and myocarditis recurrence.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"><strong><span style="background-color:white">Results: </span></strong></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#212529">We included 48 patients (95,8% males; mean age 37,0&plusmn;16,1 years old), 93,8% presenting with chest pain and 63,2% presenting with st-segment elevation on electrocardiogram. During hospitalization, 3 patients needed ionotropic support, 7 had supraventricular tachycardia, 9 non-sustained ventricular tachycardia, 1 sustained ventricular tachycardia, 1 needed extracorporeal membrane oxygenation and 9 had heart failure.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif">CMR (performed <span style="color:#212529">6 days (median) after admission)</span> showed<span style="color:#212529"> LGE in 45</span> patients (</span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">93,8%)</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#212529"> and mean left ventricular ejection fraction (LVEF) of 55,5&plusmn;8,7%.&nbsp;</span></span></span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#212529">Both groups had similar age (35,0&plusmn;13,7 vs 38,5&plusmn;17,6 years, p=0,45), cardiovascular risk factors, st-segment elevation at admission (61,9% vs 63,0%, p=0,38), pro-BNP levels at admission [</span></span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">286 (IQR 144-699) mg/dl vs 522 (IQR 222-1253) mg/dl, p = 0,20] and peak C-reactive protein [5,7 (IQR 4-12) vs 5,2 (IQR 2,6-12,5),p=0,77].</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Patients with LGE in &ge;5 segments</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"> (56,3</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">%) had lower LVEF (53,2</span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#212529">&plusmn;9,6 vs 58,2&plusmn;6,6, p=0,02), had more non-sustained ventricular tachycardia episodes (29,6% vs 4,8%, p=0,03), incidence of heart failure during hospitalization (25,9% VS 9,6%, p=0,02) and higher peak troponin levels [1,54 (IQR0,64-2,45) vs 0,594 (IQR 0,374-1,07), p=0,002].</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">During a median follow-up of 21,5 (IQR 8&ndash;35,2) months, 11 patients (22,9%) </span></span></span></span><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif">experienced the <span style="color:black">primary outcome (6 for heart failure, 4 for AM recurrence, 1 death). </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">The incidence of the primary endpoint increased by 1,20 (95% CI 1,08-1,60) for each segment involved. Patients with &ge; 5 segments had a higher incidence of this outcome (25,7 vs 5,1 per 100 patient/year, log rank p=0,02) (figure 1).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"><span style="background-color:white">After adjusting for possible cofounders, LGE&ge; 5 segments on CMR was an independent predictor of all-cause mortality, heart failure and myocarditis recurrence (HR 7,22, 95% CI 1,33-39,16).</span></span></span></span></span></span></p>

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<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"><strong><span style="background-color:white">Conclusion:</span></strong>&nbsp;</span></span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">In this study, LGE involving 5 or more segments by LGE was correlated with adverse cardiovascular events among patients with suspected myocarditis. These data suggest that cardiac resonance imaging might add value to currently existing diagnostic tools for risks assessment in AM. </span></span></span></span></span></span></p>