PMID- 34636636
OWN - NLM
STAT- MEDLINE
DCOM- 20220110
LR  - 20220110
IS  - 1527-1315 (Electronic)
IS  - 0033-8419 (Linking)
VI  - 302
IP  - 1
DP  - 2022 Jan
TI  - Subendocardial Involvement as an Underrecognized Cardiac MRI Phenotype in 
      Myocarditis.
PG  - 61-69
LID - 10.1148/radiol.2021211276 [doi]
AB  - Background Subendocardial late gadolinium enhancement (LGE) detected with cardiac 
      MRI in myocarditis represents a diagnostic dilemma, since it may resemble 
      myocardial ischemia. Purpose To explore and compare the histopathologic 
      characteristics and clinical features and outcomes in patients with myocarditis 
      with and without subendocardial involvement at cardiac MRI. Materials and Methods 
      This retrospective study evaluated 39 patients with myocarditis pathologically 
      proven by means of either endomyocardial biopsy or explant pathologic findings 
      between 2015 and 2020. Patients were divided into two groups according to cardiac 
      MRI phenotype: 18 with subendocardial involvement (mean age +/- standard deviation, 
      40 years +/- 17; 10 women) and 21 with no subendocardial involvement (mean age, 35 
      years +/- 11; six women). The median follow-up period was 784 days (interquartile 
      range [IQR], 90-1123 days). The Student t test, Mann-Whitney U test, and 
      univariable Cox regression were used for statistical analyses. Results In the 18 
      patients with subendocardial involvement, 12 (67%) had lymphocytic myocarditis 
      and six (33%) had giant cell myocarditis. Patients with subendocardial 
      involvement compared with those without subendocardial involvement had lower left 
      ventricular ejection fraction (mean +/- standard deviation, 27% +/- 11 vs 41% +/- 19; P 
      = .004), larger LGE extent (median, 13% [IQR, 10%-22%] vs 5% [IQR, 2%-17%]; P < 
      .001), higher rates of cardiac death or transplant (eight of 18 patients [44%] vs 
      one of 21 patients [4.8%]; P = .006), higher probability of giant cell 
      myocarditis (six of 18 [33%] vs one of 21 [4.8%]; P = .02), and more major 
      adverse cardiovascular events (MACE) (15 of 18 [83%] vs seven of 21 [33%]; P = 
      .002). In a subgroup of patients with comparable LGE extent (median, 15% vs 16%; 
      P = .40) and left ventricular ejection fraction (median, 27% vs 31%; P = .26), 
      the prognostic difference in terms of MACE remained (15 of 17 patients [88%] vs 
      five of 10 [50%]; P = .02). Conclusion Subendocardial involvement detected with 
      cardiac MRI in myocarditis indicated more severe clinical features, including a 
      higher frequency of severe lymphocytic myocarditis or giant cell myocarditis and 
      worse prognosis. (c) RSNA, 2021 See also the editorial by de Roos in this issue.
FAU - Li, Jing-Hui
AU  - Li JH
AUID- ORCID: 0000-0002-5095-3921
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Xu, Xi-Qi
AU  - Xu XQ
AUID- ORCID: 0000-0002-1472-6887
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Zhu, Yong-Jian
AU  - Zhu YJ
AUID- ORCID: 0000-0003-2326-1441
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Cheng, Chun-Yan
AU  - Cheng CY
AUID- ORCID: 0000-0003-1407-6594
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Lu, Min-Jie
AU  - Lu MJ
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Wang, Hong-Yue
AU  - Wang HY
AUID- ORCID: 0000-0002-4473-1353
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Wang, Yi-Ning
AU  - Wang YN
AUID- ORCID: 0000-0003-3193-2487
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Jing, Zhi-Cheng
AU  - Jing ZC
AUID- ORCID: 0000-0003-0493-0929
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
FAU - Zhao, Shi-Hua
AU  - Zhao SH
AUID- ORCID: 0000-0003-1339-7476
AD  - From the Departments of Magnetic Resonance Imaging (J.H.L., M.J.L., S.H.Z.) and 
      Pathology (H.Y.W.), Fuwai Hospital, National Center for Cardiovascular Diseases, 
      Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 
      Beilishi Rd, Beijing 100037, China; Department of Cardiology, State Key 
      Laboratory of Complex Severe and Rare Diseases (X.Q.X., Y.J.Z., Z.C.J.), and 
      Department of Radiology (Y.N.W.), Peking Union Medical College Hospital, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and 
      Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University 
      of Padua Medical School, Padova, Italy (C.Y.C.).
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20211012
PL  - United States
TA  - Radiology
JT  - Radiology
JID - 0401260
SB  - IM
CIN - Radiology. 2021 Oct 12;:212121. PMID: 34636641
MH  - Adult
MH  - Female
MH  - Heart/diagnostic imaging/physiopathology
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Myocarditis/*diagnostic imaging/*pathology
MH  - Phenotype
MH  - Retrospective Studies
EDAT- 2021/10/13 06:00
MHDA- 2022/01/11 06:00
CRDT- 2021/10/12 12:20
PHST- 2021/10/13 06:00 [pubmed]
PHST- 2022/01/11 06:00 [medline]
PHST- 2021/10/12 12:20 [entrez]
AID - 10.1148/radiol.2021211276 [doi]
PST - ppublish
SO  - Radiology. 2022 Jan;302(1):61-69. doi: 10.1148/radiol.2021211276. Epub 2021 Oct 
      12.