Author + information
- Received February 7, 2020
- Revision received April 20, 2020
- Accepted April 21, 2020
- Published online September 7, 2020.
- Kady Fischer, PHDa,b,
- Sarah J. Obrist, BMeda,∗,
- Sophie A. Erne, BMeda,∗,
- Anselm W. Stark, BMeda,
- Maximilian Marggraf, MDa,
- Kyoichi Kaneko, MD, PHDc,
- Dominik P. Guensch, MDb,d,
- Adrian T. Huber, MD, PHDd,
- Simon Greulich, MDe,
- Ayaz Aghayev, MDf,
- Michael Steigner, MDf,
- Ron Blankstein, MDf,
- Raymond Y. Kwong, MD, MPHc and
- Christoph Gräni, MD, PHDa,c,∗ ()
- aDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- bDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- cNon-invasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- dDepartment of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- eDepartment of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
- fNon-invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Christoph Gräni, Director, Non-invasive Cardiovascular Imaging, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
Objectives This study investigated the association of cardiovascular cardiac magnetic resonance (CMR) feature tracking (FT) with outcome in a patient cohort with myocarditis and evaluated the possible incremental prognostic benefit beyond clinical features and traditional CMR features.
Background CMR is used to diagnose and risk stratify patients with myocarditis. CMR-FT allows quantitative strain analysis of myocardial function; however, its prognostic benefit in myocarditis is unknown.
Methods Consecutive patients with clinically suspected myocarditis and presence of midmyocardial or epicardial late gadolinium enhancement (LGE) and/or myocardial edema in CMR were included. Clinical and CMR features were analyzed with regard to major adverse cardiovascular events (MACE) (i.e., hospitalization for heart failure, sustained ventricular tachycardia, and all-cause mortality).
Results Of 740 patients with clinically suspected myocarditis, 455 (61%) met our final diagnostic criteria based on CMR tissue characterization. At a median follow-up of 3.9 years, MACE occurred in 74 (16%) patients. In the univariable analysis, CMR-FT global longitudinal peak strain (GLS) was significantly associated with MACE. In a multivariable model adjusting for clinical variables (age, sex, body mass index, and acuteness of symptoms) and traditional CMR features (left ventricular ejection fraction [LVEF] and LGE extent), GLS remained independently associated with outcome (GLS hazard ratio: 1.21; 95% confidence interval: 1.08 to 1.36; p = 0.001) and incrementally improved prognostication (chi-square increases from 42.6 to 79.8 to 88.5; p < 0.001).
Conclusions Myocardial strain using CMR-FT provides independent and incremental prognostic value over clinical features, LVEF, and LGE in patients with myocarditis. CMR-FT may serve as a novel marker to improve risk stratification in myocarditis. (CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571)
- cardiovascular magnetic resonance
- feature tracking
- late gadolinium enhancement
- major adverse cardiac event
↵∗ Mrs. Obrist and Mrs. Erne contributed equally to this work.
Dr. Kwong has received research support from National Institutes of Health awards 1UH2 TR000901, 1RO1DK083424-01, and 1U01HL117006, Alnylam Pharmaceuticals, and the Society for the Cardiovascular Magnetic Resonance. Dr. Gräni has received funding support from the Novartis Foundation for Medical-Biological Research, Bangerter-Rhyner Foundation, Swiss Sports Medicine Society (SGSM), and Kreislauf Kardiologie Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Christopher Kramer, MD, was Guest Editor on this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received February 7, 2020.
- Revision received April 20, 2020.
- Accepted April 21, 2020.
- 2020 American College of Cardiology Foundation
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