title: Infarct-like acute myocarditis: relation between electrocardiographic findings and myocardial damage as assessed by cardiac magnetic resonance imaging.
abstract: BACKGROUND
  Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique.
  
  
  OBJECTIVE
  Myocardial damage may be associated with ECG changes in infarct-like AM.
  
  
  METHODS
  Forty-one consecutive patients (36 males; mean age, 36 ± 12 years) with diagnosis of AM according to cardiac MRI Lake Louise criteria and infarct-like presentation were included. The relation between site of ST-segment elevation (STE), sum of STE (sumSTE), time to normalization of STE, and development of negative T wave with the extent of LGE (expressed as % of left ventricular mass [%LV LGE]), was evaluated.
  
  
  RESULTS
  Most (80%) patients presented with inferolateral STE; mean sumSTE was 5 ± 3 mm. Normalization of STE occurred within 24 hours in 20 (49%) patients. Development of negative T wave occurred in 28 (68%) patients. Cardiac MRI showed LGE in all patients; mean %LV LGE was 9.6 ± 7.2%. Topographic agreement between site of STE and LGE was 68%. At multivariate analysis, sumSTE (β = 0.42, P < 0.001), normalization of STE >24 hours (β = 0.39, P < 0.001), and development of negative T wave (β = 0.49, P < 0.001) were independently related to %LV LGE.
  
  
  CONCLUSIONS
  Analysis of the site of STE underestimates the extent of myocardial injury among patients with infarct-like myocarditis. However, some ECG features (ie, sumSTE, normalization of STE >24 hours, and development of negative T wave) may help to identify patients with larger areas of myocardial damage.
authors.affiliation: Division of Cardiology, University Hospital Santa Maria della Misericordia, Udine, Italy. gnucifora@cardionet.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Daniela
authors.initials: D
authors.lastname: Miani
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Chiara
authors.forename: Gianluca
authors.initials: G
authors.lastname: Piccoli
authors.forename: Jessica
authors.initials: J
authors.lastname: Artico
authors.forename: Michela
authors.initials: M
authors.lastname: Puppato
authors.forename: Gianaugusto
authors.initials: G
authors.lastname: Slavich
authors.forename: Marzia
authors.initials: M
authors.lastname: De Biasio
authors.forename: Daniele
authors.initials: D
authors.lastname: Gasparini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
mesh_terms: D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D003287:Contrast Media; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D013318:Stroke Volume; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA