Wang Yining, Duan Xuejing, Zhu Leyi, Xu Jing, Zhou Di, Yang Wenjing, Jiang Mengdi, Zhang Huaying, Sirajuddin Arlene, Arai Andrew E, Zhao Shihua, Wang Hongyue, Lu Minjie
Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Pathology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Radiol Cardiothorac Imaging. 2025 Feb;7(1):e240125. doi: 10.1148/ryct.240125.
Purpose To investigate the prognostic value of T1 mapping, extracellular volume fraction (ECV), and T2 mapping in a large cohort of patients with acute myocarditis. Materials and Methods This retrospective study included patients with acute myocarditis who underwent cardiac MRI (3.0 T) between March 2016 and October 2022. Diagnosis was confirmed by diagnostic cardiac MRI criteria or endomyocardial biopsy. The primary end point was major adverse cardiovascular events (MACEs), defined as the composite of cardiac death, heart failure hospitalization, heart transplantation, sustained ventricular arrhythmia, and recurrent myocarditis. Univariable and multivariable Cox regression analyses were performed to assess the association of clinical and cardiac MRI variables with the primary end point. The prognostic value of each model was assessed using the Harrell C index. Results A total of 235 patients (mean age, 32 years ± 13 [SD]; 150 [63.8%] men) were included. During a mean follow-up of 1637 days (IQR: 1441-1833 days), MACEs occurred in 45 (19%) patients. Patients with MACEs had higher global native T1, ECV, and T2 values (1342 msec ± 64 vs 1263 msec ± 48; < .001; 39.1% ± 8.7 vs 32.7% ± 5.7; < .001; 61.1 msec ± 10.0 vs 55.3 msec ± 9.4; = .03, respectively). In a series of multivariable Cox regression models, native T1 (per 10-msec increase: hazard ratio, 1.61; 95% CI: 1.31, 1.98; < .001) and ECV (per 5% increase: hazard ratio, 1.70; 95% CI: 1.38, 2.08; < .001) independently predicted MACE occurrence, and the addition of native T1 (Harrell C index = 0.76) or ECV (Harrell C index = 0.79) to the model including only clinical variables, left ventricular ejection fraction, and septal late gadolinium enhancement (Harrell C index = 0.72) improved discrimination for the primary end point. Conclusion Cardiac MRI-derived native T1 and ECV were independent predictors of MACEs in patients with acute myocarditis and provided incremental prognostic value when combined with conventional parameters. MRI, Cardiac, Heart, Inflammation © RSNA, 2025.
目的 探讨T1映射、细胞外容积分数（ECV）和T2映射在一大群急性心肌炎患者中的预后价值。材料与方法 这项回顾性研究纳入了2016年3月至2022年10月期间接受心脏磁共振成像（3.0 T）的急性心肌炎患者。通过诊断性心脏磁共振成像标准或心内膜心肌活检确诊。主要终点是主要不良心血管事件（MACE），定义为心脏死亡、心力衰竭住院、心脏移植、持续性室性心律失常和复发性心肌炎的综合。进行单变量和多变量Cox回归分析，以评估临床和心脏磁共振成像变量与主要终点的关联。使用Harrell C指数评估每个模型的预后价值。结果 共纳入235例患者（平均年龄32岁±13[标准差]；150例[63.8%]为男性）。在平均1637天（四分位间距：1441 - 1833天）的随访期间，45例（占19%）患者发生了MACE。发生MACE的患者具有更高的整体固有T1、ECV和T2值（分别为1342毫秒±64与1263毫秒±48；P < .001；39.1%±8.7与32.7%±5.7；P < .001；61.1毫秒±10.0与55.3毫秒±9.4；P = .03）。在一系列多变量Cox回归模型中，固有T1（每增加10毫秒：风险比，1.61；95%置信区间：1.31，1.98；P < .001）和ECV（每增加5%：风险比，1.70；95%置信区间：[1.38，2.08]；P < .001）独立预测MACE的发生，并且在仅包含临床变量、左心室射血分数和室间隔延迟钆增强（Harrell C指数 = 0.72）的模型中加入固有T1（Harrell C指数 = 0.76）或ECV（Harrell C指数 = 0.79）可改善对主要终点的判别能力。结论 心脏磁共振成像得出的固有T1和ECV是急性心肌炎患者MACE的独立预测因素，并且与传统参数联合时可提供额外的预后价值。磁共振成像，心脏，心脏，炎症 © RSNA，2025
