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Left and right ventricular morphology, function and late gadolinium enhancement extent and localization change with different clinical presentation of acute myocarditis Data from the ITAlian multicenter study on MYocarditis (ITAMY)

Di Bella, Gianlucaa; Camastra, Giovannib; Monti, Lorenzoc; Dellegrottaglie, Santod,e; Piaggi, Paolof; Moro, Claudiog; Pepe, Alessiah; Lanzillo, Chiarai; Pontone, Gianlucaj; Perazzolo Marra, Martinak; Di Roma, Maurol; Scatteia, Alessandram; Aquaro, Giovanni D.hOn behalf of the working group ‘Cardiac Magnetic Resonance’ of the Italian Society of Cardiology

Journal of Cardiovascular Medicine: November 2017 - Volume 18 - Issue 11 - p 881–887
doi: 10.2459/JCM.0000000000000574
Research articles: Pericarditis and myocarditis

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:

Received 22 April, 2017

Revised 17 August, 2017

Accepted 22 August, 2017

© 2017 Italian Federation of Cardiology. All rights reserved.