SPC365

Correlation Between Electrocardiogram and Cardiac Magnetic Resonance Imaging in Acute Myocarditis

Session: Sessão de Posters 55 - RM Cardíaca
Speaker: Sofia Esteves

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type: Cartazes
FP Number: ---
Authors: Sofia Esteves; Marta Vilela; Catarina Simões Oliveira; Miguel Azaredo Raposo; Miguel Nobre Menezes; João Silva Marques; Beatriz Valente Silva; Joana Rigueira; Rui Plácido; Dulce Brito; Fausto J. Pinto; Ana G Almeida
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The presentation of acute myocarditis (AM) can be similar to acute coronary syndrome (ACS), with chest pain and ST segment changes. In ACS, ST segment elevation (STE) directly correlates with left ventricular wall motion changes. In acute myocarditis, the presence of STE has not been shown to directly correlate with localized findings on either echo or Cardiac Magnetic Resonance (CMR), but uncertainties remain.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Evaluate the concordance between the location of STE&nbsp;and myocardial fibrosis/necrosis assessed by late gadolinium enhancement (LGE) on CMR in acute myocarditis.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Prospective single-center study of patients diagnosed with acute myocarditis from 2007 to 2023 at a tertiary cardiology center. Comprehensive datasets comprising clinical records, imaging studies, and laboratory findings from hospital admissions were gathered and analyzed. Given the often focal nature of myocarditis, the presence of STE in a single-lead was considered positive for each wall: anterior (STE in leads V1-V4), inferior (STE in leads II, III and aVF) and lateral (STE in leads I, aVL, V5-V6). The posterior wall was excluded from the analysis. Concordance was assessed per wall individually using crosstabulation and Chi-Square testing, using CMR as reference. We also assessed concordance globally using the following criteria: LGE in a single location with matching STE, plus absence of STE in all three locations; LGE in two locations with matching of STE in at least one of them, plus absence of STE in all three locations; LGE in three walls with STE in at least two. Chi-Square was used for testing the statistical significance of individual wall concordance.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We included a cohort of 168 patients, comprising 13.6% females, with a mean age of 33&plusmn;13 years. LGE was subepicardial in 85.8% of cases, intramural in 10.8%, and transmural in 3.4%. Specifically, 22% exhibited anterior LGE, 61% manifested lateral LGE and 3% presented with inferior LGE.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding individual wall analysis, the STE accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity was 64%, 18,8%, 76,9%, 16,2% and 78,6% for the anterior wall, respectively; 60%, 25%, 68,4%, 15,7% and 79,5% for the inferior wall, respectively; and 50%, 73,8%, 42,1%, 29,8% and 82,8% for the lateral wall, respectively. Concordance was not statistically significant in any location.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Globally, the concordance of STE and LGE using the above-mentioned criteria was 64%.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In a large cohort of acute myocarditis patients, ECG STE location correlated poorly with LGE location on CMR. When findings are assessed globally using a set of partial concordance criteria, matching occurred in almost two-thirds of cases. This suggests there may be some degree of concordance between STE and LGE, which is likely limited due to the often focal and heterogeneous expression of LGE in acute myocarditis.&nbsp;</span></span></span></p>