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Erschienen in: The International Journal of Cardiovascular Imaging 6/2019

12.02.2019 | Origina Paper

Incremental value of extracellular volume assessment by cardiovascular magnetic resonance imaging in risk stratifying patients with suspected myocarditis

verfasst von: Christoph Gräni, Loïc Bière, Christian Eichhorn, Kyoichi Kaneko, Vikram Agarwal, Ayaz Aghayev, Michael Steigner, Ron Blankstein, Michael Jerosch-Herold, Raymond Y. Kwong

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 6/2019

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Abstract

Cardiovascular magnetic resonance imaging (CMR) has become a key investigative tool in patients with suspected myocarditis. However, the prognostic implications of T1 mapping, including extracellular volume (ECV) calculation, is less clear. Patients with suspected myocarditis who underwent CMR evaluation, including T1 mapping at our institution were included. CMR findings including late gadolinium enhancement (LGE), left ventricular ejection fraction (LVEF), native T1 mapping, and ECV calculation were associated with first major adverse cardiac events (MACE). MACE included a composite of all-cause death, heart failure hospitalization, heart transplantation, documented sustained ventricular arrhythmia, and recurrent myocarditis. One hundred seventy-nine patients with a mean age of 49 ± 15 years were identified. Seventy nine individuals (44%) were female. Mean LVEF was 48 ± 16. At a median follow-up of 4.1 [interquartile-range (IQR) 2.2–6.1] years, 22 (12%) patients experienced a MACE. Mean ECV (per 10%) was significantly associated with MACE (HR 2.09, 95% CI 1.07–4.08, p = 0.031). Presence of ECV ≥ 35% demonstrated significant univariable association with MACE (HR 3.3, 95% CI 1.43–7.97, p = 0.005) and such association was maintained when adjusted to LVEF (HR 3.42, 95% CI 1.42–7.94, p = 0.006). ECV ≥ 35% portended a greater than threefold increased hazards to MACE adjusted to LGE presence (HR 3.14, 95% CI 1.29–7.36, p = 0.012). In patients without LGE, ECV ≥ 35% portended a greater than sixfold increased hazards (HR 6.6, p = 0.010). In the multivariable model including age, LVEF and LGE size, only ECV ≥ 35% maintained its significant association with outcome. ECV calculation by CMR is a useful tool in the risk stratification of patients with clinically suspected myocarditis, incremental to LGE and LVEF.
Literatur
4.
Zurück zum Zitat Nakagawa M, Sato A, Okagawa H, Kondo M, Okuno M, Takamatsu T (1999) Detection and evaluation of asymptomatic myocarditis in schoolchildren: report of four cases. Chest 116(2):340–345 CrossRefPubMed Nakagawa M, Sato A, Okagawa H, Kondo M, Okuno M, Takamatsu T (1999) Detection and evaluation of asymptomatic myocarditis in schoolchildren: report of four cases. Chest 116(2):340–345 CrossRefPubMed
9.
Zurück zum Zitat Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S, Schulz-Menger J, Schelbert EB (2013) Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15:92. https://​doi.​org/​10.​1186/​1532-429x-15-92 CrossRefPubMedPubMedCentral Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S, Schulz-Menger J, Schelbert EB (2013) Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15:92. https://​doi.​org/​10.​1186/​1532-429x-15-92 CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Schelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, Valeti US, Chang CC, Shroff SG, Diez J, Miller CA, Schmitt M, Kellman P, Butler J, Gheorghiade M, Wong TC (2015) Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc. https://​doi.​org/​10.​1161/​jaha.​115.​002613 CrossRefPubMedPubMedCentral Schelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, Valeti US, Chang CC, Shroff SG, Diez J, Miller CA, Schmitt M, Kellman P, Butler J, Gheorghiade M, Wong TC (2015) Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc. https://​doi.​org/​10.​1161/​jaha.​115.​002613 CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Member (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://​doi.​org/​10.​1093/​eurheartj/​ehw128 CrossRefPubMed Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Member (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://​doi.​org/​10.​1093/​eurheartj/​ehw128 CrossRefPubMed
19.
Zurück zum Zitat Izawa H, Murohara T, Nagata K, Isobe S, Asano H, Amano T, Ichihara S, Kato T, Ohshima S, Murase Y, Iino S, Obata K, Noda A, Okumura K, Yokota M (2005) Mineralocorticoid receptor antagonism ameliorates left ventricular diastolic dysfunction and myocardial fibrosis in mildly symptomatic patients with idiopathic dilated cardiomyopathy: a pilot study. Circulation 112(19):2940–2945. https://​doi.​org/​10.​1161/​circulationaha.​105.​571653 CrossRefPubMed Izawa H, Murohara T, Nagata K, Isobe S, Asano H, Amano T, Ichihara S, Kato T, Ohshima S, Murase Y, Iino S, Obata K, Noda A, Okumura K, Yokota M (2005) Mineralocorticoid receptor antagonism ameliorates left ventricular diastolic dysfunction and myocardial fibrosis in mildly symptomatic patients with idiopathic dilated cardiomyopathy: a pilot study. Circulation 112(19):2940–2945. https://​doi.​org/​10.​1161/​circulationaha.​105.​571653 CrossRefPubMed
20.
Zurück zum Zitat Kawara T, Derksen R, de Groot JR, Coronel R, Tasseron S, Linnenbank AC, Hauer RN, Kirkels H, Janse MJ, de Bakker JM (2001) Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis. Circulation 104(25):3069–3075 CrossRefPubMed Kawara T, Derksen R, de Groot JR, Coronel R, Tasseron S, Linnenbank AC, Hauer RN, Kirkels H, Janse MJ, de Bakker JM (2001) Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis. Circulation 104(25):3069–3075 CrossRefPubMed
21.
Zurück zum Zitat Schwartzkopff B, Brehm M, Mundhenke M, Strauer BE (2000) Repair of coronary arterioles after treatment with perindopril in hypertensive heart disease. Hypertension (Dallas Tex 1979) 36(2):220–225 CrossRef Schwartzkopff B, Brehm M, Mundhenke M, Strauer BE (2000) Repair of coronary arterioles after treatment with perindopril in hypertensive heart disease. Hypertension (Dallas Tex 1979) 36(2):220–225 CrossRef
22.
Zurück zum Zitat Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, Badimon JJ, Stefanadis C, Moreno P, Pasterkamp G, Fayad Z, Stone PH, Waxman S, Raggi P, Madjid M, Zarrabi A, Burke A, Yuan C, Fitzgerald PJ, Siscovick DS, de Korte CL, Aikawa M, Juhani Airaksinen KE, Assmann G, Becker CR, Chesebro JH, Farb A, Galis ZS, Jackson C, Jang IK, Koenig W, Lodder RA, March K, Demirovic J, Navab M, Priori SG, Rekhter MD, Bahr R, Grundy SM, Mehran R, Colombo A, Boerwinkle E, Ballantyne C, Insull W Jr, Schwartz RS, Vogel R, Serruys PW, Hansson GK, Faxon DP, Kaul S, Drexler H, Greenland P, Muller JE, Virmani R, Ridker PM, Zipes DP, Shah PK, Willerson JT (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108(14):1664–1672. https://​doi.​org/​10.​1161/​01.​cir.​0000087480.​94275.​97 CrossRefPubMed Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, Badimon JJ, Stefanadis C, Moreno P, Pasterkamp G, Fayad Z, Stone PH, Waxman S, Raggi P, Madjid M, Zarrabi A, Burke A, Yuan C, Fitzgerald PJ, Siscovick DS, de Korte CL, Aikawa M, Juhani Airaksinen KE, Assmann G, Becker CR, Chesebro JH, Farb A, Galis ZS, Jackson C, Jang IK, Koenig W, Lodder RA, March K, Demirovic J, Navab M, Priori SG, Rekhter MD, Bahr R, Grundy SM, Mehran R, Colombo A, Boerwinkle E, Ballantyne C, Insull W Jr, Schwartz RS, Vogel R, Serruys PW, Hansson GK, Faxon DP, Kaul S, Drexler H, Greenland P, Muller JE, Virmani R, Ridker PM, Zipes DP, Shah PK, Willerson JT (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108(14):1664–1672. https://​doi.​org/​10.​1161/​01.​cir.​0000087480.​94275.​97 CrossRefPubMed
25.
Zurück zum Zitat Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, Mulukutla SR, Simon MA, Shroff SG, Kuller LH, Schelbert EB (2014) Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657–664. https://​doi.​org/​10.​1093/​eurheartj/​eht193 CrossRefPubMed Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, Mulukutla SR, Simon MA, Shroff SG, Kuller LH, Schelbert EB (2014) Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657–664. https://​doi.​org/​10.​1093/​eurheartj/​eht193 CrossRefPubMed
26.
Zurück zum Zitat aus dem Siepen F, Buss SJ, Messroghli D, Andre F, Lossnitzer D, Seitz S, Keller M, Schnabel PA, Giannitsis E, Korosoglou G, Katus HA, Steen H (2015) T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 16(2):210–216. https://​doi.​org/​10.​1093/​ehjci/​jeu183 CrossRefPubMed aus dem Siepen F, Buss SJ, Messroghli D, Andre F, Lossnitzer D, Seitz S, Keller M, Schnabel PA, Giannitsis E, Korosoglou G, Katus HA, Steen H (2015) T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 16(2):210–216. https://​doi.​org/​10.​1093/​ehjci/​jeu183 CrossRefPubMed
29.
Zurück zum Zitat Mascherbauer J, Marzluf BA, Tufaro C, Pfaffenberger S, Graf A, Wexberg P, Panzenbock A, Jakowitsch J, Bangert C, Laimer D, Schreiber C, Karakus G, Hulsmann M, Pacher R, Lang IM, Maurer G, Bonderman D (2013) Cardiac magnetic resonance postcontrast T1 time is associated with outcome in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging 6(6):1056–1065. https://​doi.​org/​10.​1161/​circimaging.​113.​000633 CrossRefPubMed Mascherbauer J, Marzluf BA, Tufaro C, Pfaffenberger S, Graf A, Wexberg P, Panzenbock A, Jakowitsch J, Bangert C, Laimer D, Schreiber C, Karakus G, Hulsmann M, Pacher R, Lang IM, Maurer G, Bonderman D (2013) Cardiac magnetic resonance postcontrast T1 time is associated with outcome in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging 6(6):1056–1065. https://​doi.​org/​10.​1161/​circimaging.​113.​000633 CrossRefPubMed
35.
Zurück zum Zitat Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Ntusi N, Holloway C, Choudhury RP, Kardos A, Robson MD, Friedrich MG, Neubauer S (2014) Native T1-mapping detects the location, extent and patterns of acute myocarditis without the need for gadolinium contrast agents. J Cardiovasc Magnetic Reson 16:36. https://​doi.​org/​10.​1186/​1532-429x-16-36 CrossRef Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Ntusi N, Holloway C, Choudhury RP, Kardos A, Robson MD, Friedrich MG, Neubauer S (2014) Native T1-mapping detects the location, extent and patterns of acute myocarditis without the need for gadolinium contrast agents. J Cardiovasc Magnetic Reson 16:36. https://​doi.​org/​10.​1186/​1532-429x-16-36 CrossRef
37.
Zurück zum Zitat Liu PP, Mason JW (2001) Advances in the understanding of myocarditis. Circulation 104(9):1076–1082 CrossRefPubMed Liu PP, Mason JW (2001) Advances in the understanding of myocarditis. Circulation 104(9):1076–1082 CrossRefPubMed
Metadaten
Titel
Incremental value of extracellular volume assessment by cardiovascular magnetic resonance imaging in risk stratifying patients with suspected myocarditis
verfasst von
Christoph Gräni
Loïc Bière
Christian Eichhorn
Kyoichi Kaneko
Vikram Agarwal
Ayaz Aghayev
Michael Steigner
Ron Blankstein
Michael Jerosch-Herold
Raymond Y. Kwong
Publikationsdatum
12.02.2019
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 6/2019
Print ISSN: 1569-5794
Elektronische ISSN: 1573-0743
DOI
https://doi.org/10.1007/s10554-019-01552-6

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