Czimbalmos Csilla, Szabó Liliána Erzsébet, Horváth Viktor, Dohy Zsófia, Csécs Ibolya, Tóth Attila, Suhai Ferenc Imre, Becker Dávid, Merkely Béla, Vágó Hajnalka
Semmelweis University, Heart and Vascular Center
Introduction: Most common form of myocarditis appears with the clinical signs of ST-elevation myocardial infarction. We aimed to investigate cardiac resonance imaging (CMR) characteristics of this patient population in acute stage and during follow-up (FU).
Methods: Our study was performed in 83 consecutive patients (92%male; 30.7±7.6yrs) with chest pain, localised ST-elevation, cardiac biomarker positvity but no culprit lesion on coronary angiography. Patients underwent CMR in the first 1-7 days and acute myocarditis was proved. FU CMR was performed at 3-6 months. Correlation between laboratory values (creatinin kinase MB(CKMB), C-reactive protein(CRP)) and CMR parameters were investigated. Clinical FU was performed (average FU:1502±728days).
Using cine short-axis images left ventricular volumes, mass, ejection fraction (EF), on T2-weighted images myocardial oedema, on delayed enhancement images necrosis/scar was evaluated.
Results: In 59% of the patients acute infection, in 41% of the patients intensive training or physical activity was reported before the symptoms.
On the acute CMR examination most frequent localisation of the subepicardial necrosis and oedema was the basal inferolateral segment (80%). There was a positive correlation between the extent of necrosis and CKMB level (p<0.01, r=0.41), and negative correlation between the extent of necrosis and EF (p<0.001, r=-0.36).
Comparing the acute and the FU CMR examinations EF improved (55.2±7.5 vs 60.1±5.0%), scar remained in 78% but shrank (14.4±11.4 vs 4.1±4.3g) and left ventricular mass decreased (65.3±12.4 vs 57.5±10.3) (p<0.001). Comparing patients with and without scar on FU CMR, former group had lower EF (53.9±7.2 vs 59.7±6.6%) and larger necrosis in the acute phase (16.1±12.1 vs 7.8±4.9g) (p<0.01).
During FU, mortality, hospitalization due to heart failure or arrhythmia did not occur. Recidive myocarditis was present in two cases.
Conclusion: Myocarditis mimicking ST-elevation myocardial infarction affects mainly young men and although the scar remains in 78% of patients, the clinical and CMR FU proved good prognosis.
Doctoral School: Basic and Translational Medicine
Program: Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Supervisor: Béla Merkely and Hajnalka Vago
Presenter’s email address: email@example.com