title: Myocardial biomarkers and delayed enhanced cardiac magnetic resonance relationship in clinically suspected myocarditis and insight on clinical outcome.
abstract: OBJECTIVE
  The relationship of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) with myocardial biomarkers and markers of inflammation in acute viral myocarditis is not clearly defined. We assessed the relationship of LGE with myocardial and inflammatory biomarkers measured during the acute phase of myocarditis and their predictive value on clinical outcome.
  
  
  METHODS
  Patients with first clinical episode of acute viral myocarditis and complete CMR study, including cine and LGE images, were included. The peak values of troponin I, creatine kinase, C-reactive protein value at admission and LGE extent were reported for each case. A 29-month clinical follow-up was performed, and cardiac symptoms and adverse cardiac events (all-cause death, heart transplant, hospitalization for heart failure) were reported.
  
  
  RESULTS
  Forty-one patients (39 ± 15 years and 78% men) were included. Median LGE extent was 13% [interquartile range (IQR) (9%, 19%)] of left-ventricular mass and mean left-ventricular ejection fraction was 56 ± 11%. There was a significant correlation between peak troponin I and LGE extent (r = 0.51, P < 0.001), and between peak creatine kinase and LGE extent (r = 0.66, P < 0.001). There was no correlation between C-reactive protein at admission and LGE extent (r = 0.27, P = 0.09). At follow-up, eight (20%) patients had an adverse clinical event. LGE extent was significantly associated with a worse New York Heart Association status at follow-up [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07, 1.37, P = 0.002]. After adjustment for left-ventricular ejection fraction, age and clinical presentation category, LGE extent remained an independent predictor of cardiovascular events (hazard ratio 1.42; 95% CI 1.05, 1.95, P = 0.027).
  
  
  CONCLUSIONS
  LGE extent on CMR studies is significantly correlated to biomarkers of myocardial injury in patients with acute viral myocarditis, and is a significant independent predictor of adverse cardiovascular outcome.
authors.affiliation: aHôpital Cardiovasculaire Louis Pradel, Department of Intensive and Coronary Care, Hospices Civils de Lyon, Bron bDepartment of Biostatistics, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon cHôpital Cardiovasculaire Louis Pradel, Centre d'Investigation CliniqueUnité INSERM 1407 dHôpital Cardiovasculaire Louis Pradel, Department of Radiology, Hospices Civils de Lyon, Bron, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.forename: Adeline
authors.initials: A
authors.lastname: Dernis
authors.forename: Didier
authors.initials: D
authors.lastname: Bresson
authors.forename: Oualid
authors.initials: O
authors.lastname: Zouaghi
authors.forename: Pierre
authors.initials: P
authors.lastname: Croisille
authors.forename: Elodie
authors.initials: E
authors.lastname: Flocard
authors.forename: Philippe
authors.initials: P
authors.lastname: Douek
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
mesh_terms: D000328:Adult; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D003287:Contrast Media; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000032:analysis*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D019210:Troponin I / Q000097:blood*; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D019210:Troponin I; D002097:C-Reactive Protein; D005682:Gadolinium; D003402:Creatine Kinase