Low rate of cardiovascular events in patients with acute myocarditis diagnosed by cardiovascular magnetic resonance.
BACKGROUND
Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.


METHODS
Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.


RESULTS
Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.


CONCLUSIONS
In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Luciano
L
De Stefano
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Diego
D
Perez de Arenaza
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Ezequiel Levy
EL
Yeyati
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Marcelo
M
Pietrani
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Andres
A
Kohan
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Mariano
M
Falconi
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Juan
J
Benger
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Laura
L
Dragonetti
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Ricardo
R
Garcia-Monaco
1 Cardiology Department, 2 Radiology Department, Hospital Italiano de Buenos Aires, Argentina.
Arturo
A
Cagide
Cardiac events; MRI; myocarditis