University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
Am J Cardiol. 2018 Dec 1;122(11):1955-1958. doi: 10.1016/j.amjcard.2018.08.038. Epub 2018 Sep 13.
Recent data suggest that myocardial septal late gadolinium enhancement (LGE) may have an independent prognostic value in patients with acute myocarditis undergoing cardiac magnetic resonance (CMR). Aim of the present study is to evaluate its prevalence and prognostic implications in these patients with or without preserved LV function. Retrospective cohort study including all cases of clinically suspected acute myocarditis referred for CMR. A diagnosis of acute myocarditis was confirmed by CMR according to Lake Louise Criteria. Cardiovascular mortality, heart failure, heart transplantation, and sustained ventricular arrhythmias were considered adverse events at follow-up. Seventy-one patients were included in the present study (mean age 47 years 95% confidence intervals 42 to 51, 53 males; 75%). Left Ventricular Ejection Fraction (LVEF) was preserved in 45 cases (63%) and pericardial effusion was detected in 26 cases (38%). CMR was performed at a mean time of 11 days (95% confidence intervals 7.5 to 14.4) from symptoms onset. Myocardial hyperemia and edema were detected in 53 cases (75%), myocardial LGE in 66 cases (93%). Septal LGE was reported in 21 cases (30%). After a mean follow-up of 60.8 months, the mean LVEF increased from 51.6 ± 14.0% to 56.6 ± 10.9% (p = 0.021) and combined adverse events were only recorded in 4 patients (6%) with reduced basal LVEF. These patients had more commonly septal LGE (respectively 58% vs13%, p <0.0001). However, on multivariable analysis septal LGE had no additional predictive value over reduced basal LVEF. In conclusion, our study suggests that septal LGE is not uncommon in patients with acute myocarditis but has no added prognostic value over reduced LVEF at presentation.
最近的数据表明，心肌间隔晚期钆增强（LGE）在接受心脏磁共振（CMR）检查的急性心肌炎患者中可能具有独立的预后价值。本研究的目的是评估其在左心室射血分数（LVEF）正常或异常的这些患者中的患病率和预后意义。
本研究为回顾性队列研究，纳入所有因疑似急性心肌炎而行 CMR 检查的患者。根据湖景标准诊断为急性心肌炎。心血管死亡率、心力衰竭、心脏移植和持续性室性心律失常被认为是随访时的不良事件。本研究共纳入 71 例患者（平均年龄 47 岁，95%置信区间 42 至 51，53 例男性；75%）。45 例（63%）患者 LVEF 正常，26 例（38%）患者有心包积液。CMR 检查在症状发作后 11 天（95%置信区间 7.5 至 14.4）进行。53 例（75%）患者检测到心肌充血和水肿，66 例（93%）患者检测到心肌 LGE。21 例（30%）患者存在间隔 LGE。平均随访 60.8 个月后，LVEF 从 51.6±14.0%增加到 56.6±10.9%（p=0.021），仅 4 例（6%）患者因基础 LVEF 降低而发生联合不良事件。这些患者更常见间隔 LGE（分别为 58%和 13%，p<0.0001）。然而，多变量分析显示，间隔 LGE 对基础 LVEF 降低的预测价值没有增加。
总之，我们的研究表明，在急性心肌炎患者中，间隔 LGE 并不少见，但与发病时的 LVEF 降低相比，其预后价值没有增加。
