PMID- 30813942 OWN - NLM STAT- MEDLINE DCOM- 20200128 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 21 IP - 1 DP - 2019 Feb 28 TI - Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis. PG - 14 LID - 10.1186/s12968-019-0520-0 [doi] LID - 14 AB - BACKGROUND: Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. METHODS: Six hundred seventy consecutive patients (48 +/- 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods. RESULTS: Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02-1.08, p = 0.001; HR 1.02, 95%CI:1.00-1.04; p = 0.001; HR 1.02, 95%CI: 1.00-1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04-1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values. CONCLUSIONS: FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients. TRIAL REGISTRATION NUMBER: NCT03470571 . Registered 13th March 2018. Retrospectively registered. FAU - Grani, Christoph AU - Grani C AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. FAU - Eichhorn, Christian AU - Eichhorn C AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. FAU - Biere, Loic AU - Biere L AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. FAU - Kaneko, Kyoichi AU - Kaneko K AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. FAU - Murthy, Venkatesh L AU - Murthy VL AD - Cardiovascular Imaging, Department of Radiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA. FAU - Agarwal, Vikram AU - Agarwal V AD - Noninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Aghayev, Ayaz AU - Aghayev A AD - Noninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Steigner, Michael AU - Steigner M AD - Noninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Blankstein, Ron AU - Blankstein R AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. AD - Noninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Jerosch-Herold, Michael AU - Jerosch-Herold M AD - Noninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Kwong, Raymond Y AU - Kwong RY AD - Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. rykwong@bwh.harvard.edu. AD - Cardiac Magnetic Resonance Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. rykwong@bwh.harvard.edu. LA - eng SI - ClinicalTrials.gov/NCT03470571 GR - UH2 TR000901/TR/NCATS NIH HHS/United States GR - R01 DK083424/DK/NIDDK NIH HHS/United States GR - U01 HL117006/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20190228 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 15G12L5X8K (gadobenic acid) RN - 6HG8UB2MUY (Meglumine) RN - K2I13DR72L (Gadolinium DTPA) SB - IM MH - Adult MH - Contrast Media/administration & dosage MH - Female MH - Fibrosis MH - Gadolinium DTPA/administration & dosage MH - Humans MH - Image Interpretation, Computer-Assisted/*methods MH - Magnetic Resonance Imaging/*methods MH - Male MH - Meglumine/administration & dosage/analogs & derivatives MH - Middle Aged MH - Myocarditis/*diagnostic imaging/pathology MH - Myocardium/*pathology MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Severity of Illness Index PMC - PMC6393997 OTO - NOTNLM OT - CMR OT - Cardiovascular magnetic resonance imaging OT - FWHM OT - Full width half maximum OT - MACE OT - Myocarditis OT - Outcome OT - Quantification method OT - SD OT - Standard deviation COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: All study procedures were reviewed and approved by our Institutional Review Board at Brigham and Women's Hospital, Harvard Medical School Boston in accordance with institutional guidelines. Given the retrospective nature of the current data spanning the past decade, obtaining informed consent from each patient was not logistically feasible, and a waiver for signing informed consent was obtained from by our Institutional Review Board. For patients who were followed-up by email or phone, signed informed consent is available. CONSENT FOR PUBLICATION: Not applicable COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2019/03/01 06:00 MHDA- 2020/01/29 06:00 PMCR- 2019/02/28 CRDT- 2019/03/01 06:00 PHST- 2018/03/20 00:00 [received] PHST- 2019/01/04 00:00 [accepted] PHST- 2019/03/01 06:00 [entrez] PHST- 2019/03/01 06:00 [pubmed] PHST- 2020/01/29 06:00 [medline] PHST- 2019/02/28 00:00 [pmc-release] AID - S1097-6647(23)00187-4 [pii] AID - 520 [pii] AID - 10.1186/s12968-019-0520-0 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2019 Feb 28;21(1):14. doi: 10.1186/s12968-019-0520-0.