Mewton Nathan, Dernis Adeline, Bresson Didier, Zouaghi Oualid, Croisille Pierre, Flocard Elodie, Douek Philippe, Bonnefoy-Cudraz Eric
aHôpital Cardiovasculaire Louis Pradel, Department of Intensive and Coronary Care, Hospices Civils de Lyon, Bron bDepartment of Biostatistics, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon cHôpital Cardiovasculaire Louis Pradel, Centre d'Investigation CliniqueUnité INSERM 1407 dHôpital Cardiovasculaire Louis Pradel, Department of Radiology, Hospices Civils de Lyon, Bron, France.
J Cardiovasc Med (Hagerstown). 2015 Oct;16(10):696-703. doi: 10.2459/JCM.0000000000000024.
The relationship of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) with myocardial biomarkers and markers of inflammation in acute viral myocarditis is not clearly defined. We assessed the relationship of LGE with myocardial and inflammatory biomarkers measured during the acute phase of myocarditis and their predictive value on clinical outcome.
Patients with first clinical episode of acute viral myocarditis and complete CMR study, including cine and LGE images, were included. The peak values of troponin I, creatine kinase, C-reactive protein value at admission and LGE extent were reported for each case. A 29-month clinical follow-up was performed, and cardiac symptoms and adverse cardiac events (all-cause death, heart transplant, hospitalization for heart failure) were reported.
Forty-one patients (39 ± 15 years and 78% men) were included. Median LGE extent was 13% [interquartile range (IQR) (9%, 19%)] of left-ventricular mass and mean left-ventricular ejection fraction was 56 ± 11%. There was a significant correlation between peak troponin I and LGE extent (r = 0.51, P < 0.001), and between peak creatine kinase and LGE extent (r = 0.66, P < 0.001). There was no correlation between C-reactive protein at admission and LGE extent (r = 0.27, P = 0.09). At follow-up, eight (20%) patients had an adverse clinical event. LGE extent was significantly associated with a worse New York Heart Association status at follow-up [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07, 1.37, P = 0.002]. After adjustment for left-ventricular ejection fraction, age and clinical presentation category, LGE extent remained an independent predictor of cardiovascular events (hazard ratio 1.42; 95% CI 1.05, 1.95, P = 0.027).
LGE extent on CMR studies is significantly correlated to biomarkers of myocardial injury in patients with acute viral myocarditis, and is a significant independent predictor of adverse cardiovascular outcome.
心脏磁共振成像（CMR）延迟钆增强（LGE）与急性病毒性心肌炎中心肌生物标志物及炎症标志物之间的关系尚未明确界定。我们评估了LGE与心肌炎急性期所测心肌及炎症生物标志物之间的关系，以及它们对临床结局的预测价值。
纳入首次临床发作急性病毒性心肌炎且有完整CMR检查（包括电影成像和LGE图像）的患者。报告每例患者肌钙蛋白I、肌酸激酶的峰值，入院时C反应蛋白值及LGE范围。进行了为期29个月的临床随访，并报告心脏症状和不良心脏事件（全因死亡、心脏移植、因心力衰竭住院）。
纳入41例患者（年龄39±15岁，男性占78%）。LGE范围的中位数为左心室质量的13%[四分位间距（IQR）（9%，19%）]，左心室平均射血分数为56±11%。肌钙蛋白I峰值与LGE范围之间存在显著相关性（r = 0.51，P < 0.001），肌酸激酶峰值与LGE范围之间也存在显著相关性（r = 0.66，P < 0.001）。入院时C反应蛋白与LGE范围之间无相关性（r = 0.27，P = 0.09）。随访时，8例（20%）患者发生不良临床事件。LGE范围与随访时较差的纽约心脏协会心功能分级显著相关[比值比（OR）1.21，95%置信区间（CI）1.07，1.37，P = 0.002]。在对左心室射血分数、年龄和临床表现类别进行校正后，LGE范围仍然是心血管事件的独立预测因子（风险比1.42；95%CI 1.05，1.95，P = 0.027）。
CMR研究中的LGE范围与急性病毒性心肌炎患者的心肌损伤生物标志物显著相关，并且是不良心血管结局的显著独立预测因子。
