Author + information
- Received September 19, 2017
- Revision received November 13, 2017
- Accepted December 6, 2017
- Published online November 5, 2018.
- Christos P. Kotanidis, MD, MSca,
- Maria-Anna Bazmpani, MDa,
- Anna-Bettina Haidich, PhDb,
- Charalambos Karvounis, MD, PhDa,
- Charalambos Antoniades, MD, PhDc and
- Theodoros D. Karamitsos, MD, PhDa,∗ ()
- aFirst Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- bDepartment of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Greece
- cDivision of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- ↵∗Address for correspondence:
Prof. Theodoros D. Karamitsos, First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, 55136, St. Kyriakidi 1 Street, Thessaloniki, Greece.
Objectives The purpose of this systematic review was to explore the diagnostic accuracy of various cardiovascular magnetic resonance (CMR) index tests for the diagnosis of acute myocarditis in adult patients.
Background Acute myocarditis remains one of the most challenging diagnoses in cardiology. CMR has emerged as the diagnostic tool of choice to detect acute myocardial injury and necrosis in patients with suspected myocarditis.
Methods We considered all diagnostic cohort and case-control studies. We searched MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science up to April 21, 2017. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to assess the quality of included studies. PROSPERO registration number CRD42017055778 was used.
Results Twenty-two studies were included in the systematic review. Because significant heterogeneity exists among the studies, we only present hierarchical receiver operator curves. The areas under the curve (AUC) for each index test were for T1 mapping 0.95 (95% confidence interval [CI]: 0.93 to 0.97), for T2 mapping 0.88 (95% CI: 0.85 to 0.91), for extracellular volume fraction (ECV) 0.81 (95% CI: 0.78 to 0.85), for increased T2 ratio/signal 0.80 (95% CI: 0.76 to 0.83), for late gadolinium enhancement (LGE) 0.87 (95% CI: 0.84 to 0.90), for early gadolinium enhancement (EGE) 0.78 (95% CI: 0.74 to 0.81), and for the Lake Louise criteria (LLC) 0.81 (95% CI: 0.77 to 0.84). Native T1 mapping had superior diagnostic accuracy across all index tests. The AUC of T2 mapping was greater than the AUC of increased T2 ratio/signal and EGE, whereas ECV showed no superiority compared with other index tests. LGE had better diagnostic accuracy compared with the classic CMR index tests, similar accuracy with T2 mapping and ECV, and only T1 mapping surpassed it.
Conclusions Novel CMR mapping techniques provide high diagnostic accuracies for the diagnosis of acute myocarditis and constitute promising successors of the classic elements of the LLC for routine diagnostic protocols.
Dr. Kotanidis has received support from the Alexandros S. Onassis Public Benefit Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2017.
- Revision received November 13, 2017.
- Accepted December 6, 2017.
- 2018 American College of Cardiology Foundation