PMID- 29025553 OWN - NLM STAT- MEDLINE DCOM- 20171019 LR - 20220318 IS - 1558-3597 (Electronic) IS - 0735-1097 (Print) IS - 0735-1097 (Linking) VI - 70 IP - 16 DP - 2017 Oct 17 TI - Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis. PG - 1964-1976 LID - S0735-1097(17)39382-8 [pii] LID - 10.1016/j.jacc.2017.08.050 [doi] AB - BACKGROUND: Diagnosing myocarditis is challenged by nonspecific clinical signs and symptoms and low accuracy of endomyocardial biopsy. Cardiac magnetic resonance imaging (CMR) provides both cardiac anatomy and tissue characterization in this setting, but the prognostic value of this method as a primary assessment tool in patients with suspected myocarditis remains limited. OBJECTIVES: This study sought to determine cardiac event-free survival of a consecutive cohort with suspected myocarditis with regard to CMR findings. METHODS: Six hundred seventy patients with suspected myocarditis underwent CMR including late gadolinium enhancement (LGE) parameters between 2002 and 2015 and were included and followed. We performed multivariable model for major adverse cardiovascular events (MACE) and determined the continuous net reclassification improvement by LGE markers. RESULTS: At a median follow-up of 4.7 years (interquartile range [IQR]: 2.3 to 7.3 years), 98 patients experienced a MACE. Two hundred ninety-four (44%) patients showed LGE presence, which was associated with a more than doubling risk of MACE (hazard ratio [HR]: 2.22; 95% confidence interval [CI]: 1.47 to 3.35; p < 0.001). Annualized MACE rates were 4.8% and 2.1% corresponding to LGE presence and absence, respectively (p < 0.001). In the multivariable model, LGE presence maintained significant association with MACE (HR: 1.72; 95% CI: 1.08 to 2.76; p = 0.023). The computed continuous net reclassification improvement was 0.39 (95% CI: 0.10 to 0.67) when LGE presence was added to the multivariable model for MACE. Regarding location and pattern, septal and midwall LGE showed strongest associations with MACE (HR: 2.55; 95% CI: 1.77 to 3.83 and HR: 2.39; 95% CI: 1.54 to 3.69, respectively; both p < 0.001). A patchy distribution portended to a near 3-fold increased hazard to MACE (HR: 2.93; 95% CI: 1.79 to 4.80; p < 0.001). LGE extent (per 10% increase) corresponded to a 79% increase in risk of MACE (HR: 1.79; 95% CI: 1.25 to 2.57; p = 0.002). A normal CMR study corresponded to low annual MACE and death rates of 0.8% and 0.3%, respectively. CONCLUSIONS: CMR tissue characterization provides effective risk stratification in patients with suspected myocarditis. CI - Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Grani, Christoph AU - Grani C AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Eichhorn, Christian AU - Eichhorn C AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Biere, Loic AU - Biere L AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Murthy, Venkatesh L AU - Murthy VL AD - Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan. FAU - Agarwal, Vikram AU - Agarwal V AD - Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Kaneko, Kyoichi AU - Kaneko K AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Cuddy, Sarah AU - Cuddy S AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Aghayev, Ayaz AU - Aghayev A AD - Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Steigner, Michael AU - Steigner M AD - Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Blankstein, Ron AU - Blankstein R AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Jerosch-Herold, Michael AU - Jerosch-Herold M AD - Noninvasive Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Kwong, Raymond Y AU - Kwong RY AD - Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rykwong@partners.org. LA - eng GR - R01 HL136685/HL/NHLBI NIH HHS/United States PT - Case Reports PT - Journal Article PL - United States TA - J Am Coll Cardiol JT - Journal of the American College of Cardiology JID - 8301365 SB - IM CIN - J Am Coll Cardiol. 2017 Oct 17;70(16):1988-1990. PMID: 29025555 EIN - J Am Coll Cardiol. 2017 Nov 28;70(21):2736. PMID: 29169489 MH - Adult MH - Aged MH - Cohort Studies MH - Electrocardiography/methods/standards MH - Female MH - Follow-Up Studies MH - Humans MH - Magnetic Resonance Imaging, Cine/*methods/standards MH - Male MH - Middle Aged MH - Myocarditis/*diagnostic imaging/*physiopathology MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Young Adult PMC - PMC6506846 MID - NIHMS1027495 OTO - NOTNLM OT - CMR OT - cardiovascular magnetic resonance imaging OT - extracellular volume OT - myocarditis OT - outcome COIS- All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2017/10/14 06:00 MHDA- 2017/10/20 06:00 PMCR- 2019/05/09 CRDT- 2017/10/14 06:00 PHST- 2017/05/10 00:00 [received] PHST- 2017/08/22 00:00 [revised] PHST- 2017/08/23 00:00 [accepted] PHST- 2017/10/14 06:00 [entrez] PHST- 2017/10/14 06:00 [pubmed] PHST- 2017/10/20 06:00 [medline] PHST- 2019/05/09 00:00 [pmc-release] AID - S0735-1097(17)39382-8 [pii] AID - 10.1016/j.jacc.2017.08.050 [doi] PST - ppublish SO - J Am Coll Cardiol. 2017 Oct 17;70(16):1964-1976. doi: 10.1016/j.jacc.2017.08.050.