Ghionzoli Nicolò, Gismondi Annalaura, Mandoli Giulia Elena, Spera Lucia, Di Florio Alex, D'Ascenzi Flavio, Cameli Matteo, Cavigli Luna, Sciaccaluga Carlotta, Carbone Salvatore Francesco, Aquaro Giovanni Donato, Valente Serafina, Focardi Marta
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy.
Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Viale Bracci 16, 53100 Siena, Italy.
J Clin Med. 2022 Oct 14;11(20):6082. doi: 10.3390/jcm11206082.
: Cardiac Magnetic Resonance (CMR) has a key role in subjects presenting with acute myocarditis, independent from left ventricular ejection fraction; it is widely used as a non-invasive imaging test for both diagnostic and prognostic purposes. However, poor data is available about the CMR-derived prognostic parameters of acute myocarditis with preserved ejection fraction (AMpEF). The aim of this study was to investigate the role of CMR in predicting outcomes in patients followed up for AMpEF, using a composite endpoint of all-cause mortality and hospitalization for heart failure (HF). : We retrospectively enrolled 61 patients with diagnosed AMpEF. All patients underwent biohumoral, echocardiographic and CMR evaluation in the acute phase. Myocarditis was confirmed by Lake-Louis criteria assessed on CMR images. Mean follow-up was 4.8 ± 0.6 years during which a composite endpoint of all-cause mortality and hospitalization for HF was investigated. : The population was fairly homogeneous regarding baseline clinical features. In particular, no significant differences in age and main cardiovascular risk factors were found between patients with and without events at follow-up. Seven patients met the endpoint. They had significantly higher levels of circulating neutrophils in the acute phase (76 ± 7% vs. 61 ± 11%, = 0.014) and a higher amount of left ventricular mass with delayed enhancement (DE-LVM, 18 (14-29.5) vs. 12 (8-16) g, = 0.028). At Cox univariate analysis, DE-LVM was the only significant predictor of endpoint, regardless of the site of inflammation. : DE-LVM can predict the composite endpoint of all-cause mortality and hospitalization for HF in a population of patients with AMpEF, representing a new added tool for prognostic stratification.
心脏磁共振成像（CMR）在急性心肌炎患者中发挥着关键作用，与左心室射血分数无关；它作为一种非侵入性成像检查被广泛用于诊断和预后评估。然而，关于射血分数保留的急性心肌炎（AMpEF）的CMR衍生预后参数的可用数据较少。本研究的目的是使用全因死亡率和心力衰竭（HF）住院的复合终点，探讨CMR在预测AMpEF患者随访结局中的作用。
我们回顾性纳入了61例确诊为AMpEF的患者。所有患者在急性期均接受了生物体液、超声心动图和CMR评估。根据CMR图像评估的Lake-Louis标准确诊心肌炎。平均随访时间为4.8±0.6年，在此期间对全因死亡率和HF住院的复合终点进行了研究。
该人群在基线临床特征方面相当同质。特别是，随访时有事件发生和无事件发生的患者在年龄和主要心血管危险因素方面没有显著差异。7例患者达到终点。他们在急性期循环中性粒细胞水平显著更高（76±7%对61±11%，P=0.014），左心室质量增加且延迟强化（DE-LVM，18（14-29.5）对12（8-16）g，P=0.028）。在Cox单因素分析中，无论炎症部位如何，DE-LVM是终点的唯一显著预测因素。
DE-LVM可以预测AMpEF患者人群中全因死亡率和HF住院的复合终点，是一种新的预后分层工具。
