Aims: Poor data exist about cardiac magnetic resonance (CMR) findings in a large sample of acute myocarditis with different clinical presentations (heart failure, arrhythmias, and infarct-like presentation).
Methods: Five hundred and forty-three in-patients with a clinical suspected of acute myocarditis confirmed by CMR were enrolled. The clinical indications to perform CMR were chest pain and/or dyspnea and/or palpitations, or effort intolerance/malaise in the last month; elevated troponin and/or new ventricular dysfunction, and/or new ECG abnormalities; and suspected inflammatory cause. CMR examination has permitted to identify epicardial and mid-layer distribution of late gadolinium enhancement (LGE) and to quantify left ventricular (LV) and right ventricular (RV) volumes, and ejection fraction.
Results: According to the main clinical pattern of presentation, three groups were categorized: heart failure (heart failure group; 35 patients, 6.4%), arrhythmias (arrhythmias group; 24 patients, 4.4%), and infarct-like (infarct-like group, 484 patients, 89.2%).
Heart failure group and arrhythmias group had significantly higher LV volumes and number of LGE segments and lower LV and RV ejection fraction than the infarct-like group.
Epicardial LGE in the LV inferolateral wall was the most frequent LGE location in each group. Mid-layer LV septal LGE showed a greater prevalence in the heart failure (52%) and arrhythmias (47%) groups than in the infarct-like group (27%, P < 0.0001).
Conclusion: In patients with CMR-detected acute myocarditis, heart failure, and arrhythmias have both a higher prevalence of LV and RV dysfunction, segments with LGE, and septal LGE with respect to the infarct-like group.
aClinical and Experimental Department of Medicine, University of Messina, Messina
bCardiac Department, Vannini Hospital Rome, Roma
cRadiology Department, Humanitas Research Hospital, I.R.C.C.S., Milan
dDivision of Cardiology, Villa dei Fiori, Napoli, Italy
eMount Sinai School of Medicine, New York, New York, USA
fSection of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
gU.O. Cardiologia e UTIC, ASST Monza, P.O. Desio, Desio
hGabriele Monasterio Foundation-CNR Region Toscana, Pisa
iCardiology Department, Policlinico Casilino, Rome
jCardiac Department, Centro cardiologico Monzino, Milano
kDivision of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua
lRadiological Department, European Hospital, Roma
mDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
Correspondence to Gianluca Di Bella, MD, PhD, Clinical and Experimental Department of Medicine, University of Messina, Via Consolare Valeria No. 1, 98100 Messina, Italy Tel: +39 0902213531; e-mail: firstname.lastname@example.org
Received 22 April, 2017
Revised 17 August, 2017
Accepted 22 August, 2017