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Abstract：
BACKGROUND: Cardiac magnetic resonance (cMRI) is often used to diagnose acute myocarditis (AM). It is also performed after 6 months to monitor myocardial involvement. However, the clinical and predictive relevance of the 6-month cMRI is uncertain.
OBJECTIVE: We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode.
METHODS: We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months.
RESULTS: Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p < 0.001), myocardial edema (p < 0.001), presence of LGE (p < 0.05) and LGE mass (p < 0.01), native T1 mapping (p < 0.001), and presence of pericardial collection (p ≤ 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11-1.99], p < 0.001), myocardial edema (OR = 1.70 [1.14-209.3], p < 0.001), and prolonged native T1 (OR = 0.97 [0.88-3.06], p < 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors.
CONCLUSIONS: LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.
OBJECTIVE: We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode.
METHODS: We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months.
RESULTS: Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p < 0.001), myocardial edema (p < 0.001), presence of LGE (p < 0.05) and LGE mass (p < 0.01), native T1 mapping (p < 0.001), and presence of pericardial collection (p ≤ 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11-1.99], p < 0.001), myocardial edema (OR = 1.70 [1.14-209.3], p < 0.001), and prolonged native T1 (OR = 0.97 [0.88-3.06], p < 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors.
CONCLUSIONS: LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.
摘要：
背景：心脏磁共振（cMRI）通常用于诊断急性心肌炎（AM）。它也在6个月后进行，以监测心肌受累。然而,6个月cMRI的临床和预测相关性尚不确定.
目的：我们使用cMRI评估AM患者的形态和心功能，左心室重构与心功能不全和心肌纤维化的生物标志物之间的相关性，以及急性发作初期和6个月后心肌纤维化的参与。
方法：我们对90名临床怀疑为AM的患者进行了前瞻性研究，其中cMRI在症状发作后的第一周内进行，并在6个月后重复。
结果：88例（97.7％）患者存在非缺血性晚期钆增强（LGE），主要累及隔膜和下壁。6个月时的cMRI与节段动力学异常显着减少相关（p<0.001），心肌水肿（p<0.001），存在LGE（p<0.05）和LGE质量（p<0.01），原生T1映射(p<0.001)，和心包集合的存在（p≤0.001）。6个月时,34.4%的患者出现心肌水肿征象,在8.8%的患者中发现完全治愈(无水肿和LGE)。15.2%的患者LGE消失,涉及的心肌节段的平均数量从46％下降到30％，13％的患者保持不变。无水肿的LGE患者的预后状况比持续性水肿的患者更严重。对照cMRI上LGE延伸增加的患者的预后比LGE改良或低的患者差。主要心血管事件（MACEs）的最重要的独立预测参数是LGE质量（校正OR=1.27[1.11-1.99]，p<0.001)，心肌水肿（OR=1.70[1.14-209.3]，p<0.001)，和延长的自然T1(OR=0.97[0.88-3.06]，p<0.001)。LGE的中壁模型和无水肿LGE的存在是MACE独立的预测因子。
结论：LGE，心肌水肿，和延长的天然T1是MACEs的预测因子。LGE不一定意味着在存在水肿的情况下构成的纤维化,并且可以随时间消失。没有水肿的LGE可能代表纤维化，而水肿的持续表现为活动性炎症，可能与完全恢复的残余机会有关。应在6个月时对所有AM患者进行cMRI，以评估进展和预后。
目的：我们使用cMRI评估AM患者的形态和心功能，左心室重构与心功能不全和心肌纤维化的生物标志物之间的相关性，以及急性发作初期和6个月后心肌纤维化的参与。
方法：我们对90名临床怀疑为AM的患者进行了前瞻性研究，其中cMRI在症状发作后的第一周内进行，并在6个月后重复。
结果：88例（97.7％）患者存在非缺血性晚期钆增强（LGE），主要累及隔膜和下壁。6个月时的cMRI与节段动力学异常显着减少相关（p<0.001），心肌水肿（p<0.001），存在LGE（p<0.05）和LGE质量（p<0.01），原生T1映射(p<0.001)，和心包集合的存在（p≤0.001）。6个月时,34.4%的患者出现心肌水肿征象,在8.8%的患者中发现完全治愈(无水肿和LGE)。15.2%的患者LGE消失,涉及的心肌节段的平均数量从46％下降到30％，13％的患者保持不变。无水肿的LGE患者的预后状况比持续性水肿的患者更严重。对照cMRI上LGE延伸增加的患者的预后比LGE改良或低的患者差。主要心血管事件（MACEs）的最重要的独立预测参数是LGE质量（校正OR=1.27[1.11-1.99]，p<0.001)，心肌水肿（OR=1.70[1.14-209.3]，p<0.001)，和延长的自然T1(OR=0.97[0.88-3.06]，p<0.001)。LGE的中壁模型和无水肿LGE的存在是MACE独立的预测因子。
结论：LGE，心肌水肿，和延长的天然T1是MACEs的预测因子。LGE不一定意味着在存在水肿的情况下构成的纤维化,并且可以随时间消失。没有水肿的LGE可能代表纤维化，而水肿的持续表现为活动性炎症，可能与完全恢复的残余机会有关。应在6个月时对所有AM患者进行cMRI，以评估进展和预后。
