Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Both ST elevation (STE) on ECG and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are related to poor outcome in myocarditis.
Purpose
We evaluated if there is an association between regional STE and LGE pattern in patients with suspected myocarditis.
Methods
51 patients (42 male, 32 ± 13 years old) underwent 12-lead ECG and CMR with LGE due to suspected myocarditis. >1mm STE was assessed in the antero-septal (V1-V4, aVR), inferior (II, III, aVF) and lateral (I, aVL, V5-V6) localizations. LGE was quantified as visual presence score (VPS) (1-17) and visual transmurality score (VTS) (1-68) on CMR, according to the 17-segment AHA model. STE and LGE were correlated using linear regression analysis.
Results
31% of the patients had STE on admission ECG and a median VPS of 3 (IQR: 1-5) and VTS of 6 (IQR: 3-11) on CMR. STE showed an association with VPS and VTS in univariate and multivariate analysis (p < 0.001 all). STE was most frequent in the lateral and inferior leads (48% and 31%) which correlated with regional VPS and VTS in univariate model (p < 0.05 all), and remained significant in multivariate analysis for VPS (p < 0.05 both). STE was less frequent in the antero-septal region (21%, where no association between LGE and STE could be revealed (p > 0.05 all).
Conclusions
Inferior and lateral STE in myocarditis is associated with regional LGE on CMR, which is an indicator of myocardial fibrosis and possible poor outcome. Our results need not be validated on larger cohorts with follow-up.
Could the unfortunate outcome of pediatric acute myocarditis be predicted? Factors contributing to a poor outcome in myocarditis
