title: Cardiovascular magnetic resonance predictors of clinical outcome in patients with suspected acute myocarditis.
abstract: BACKGROUND
  The natural history of acute myocarditis (AM) remains highly variable and predictors of outcome are largely unknown. The objectives were to determine the potential value of various cardiovascular magnetic resonance (CMR) parameters for the prediction of adverse long-term outcome in patients presenting with suspected AM.
  
  
  METHODS
  In a single-centre longitudinal prospective study, 203 routine consecutive patients with an initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were followed over a mean period of 18.9 ± 8.2 months. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined Major Adverse Clinical Events (MACE) (cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes).
  
  
  RESULTS
  The vast majority of patients (N = 143,70 %) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3 ± 2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2 CMR, and extent of late gadolinium enhancement lesions). Out of the 203 patients, 22 experienced at least one major cardiovascular event (10.8 %) during follow-up for a total of 31 major cardiovascular events. Among all CMR parameters, the only independent CMR predictor of adverse clinical outcome by multivariate analysis was an initial alteration of LVEF (p = 0.04).
  
  
  CONCLUSIONS
  In routine consecutive patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence and extent of myocardial edema and the extent of late gadolinium-enhanced LV myocardial lesions were not predictive of outcome. The only independent CMR predictor of adverse clinical outcome was an initial alteration of LVEF.
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. francesca.sanguineti@gmail.com.
authors: Francesca
authors: F
authors: Sanguineti
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. p.garot@icps.com.fr.
authors: Philippe
authors: P
authors: Garot
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. meligas@gmail.com.
authors: Melina
authors: M
authors: Mana
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. darachohici@gmail.com.
authors: Darach
authors: D
authors: O'h-Ici
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. t.hovasse@icps.com.fr.
authors: Thomas
authors: T
authors: Hovasse
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. t.unterseeh@icps.com.fr.
authors: Thierry
authors: T
authors: Unterseeh
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. y.louvard@icps.com.fr.
authors: Yves
authors: Y
authors: Louvard
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. xav-troussier@hotmail.fr.
authors: Xavier
authors: X
authors: Troussier
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. mc.morice@icps.com.fr.
authors: Marie-Claude
authors: MC
authors: Morice
authors: The Hôpital Privé Jacques Cartier - ICPS, CMR Department, Ramsay-Générale de Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France. j.garot@icps.com.fr.
authors: Jérôme
authors: J
authors: Garot
mesh_terms: D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D003287:Contrast Media; D018450:Disease Progression; D004489:Edema, Cardiac / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005602:France; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D015999:Multivariate Analysis; D009205:Myocarditis / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine