title: Prognostic value of the infarct- and non-infarct like patterns and cardiovascular magnetic resonance parameters on long-term outcome of patients after acute myocarditis.
abstract: BACKGROUND
  Prognostic value of the infarct- and non-infarct like patterns and cardiac magnetic resonance (CMR) parameters on long-term outcome of patients after acute myocarditis is not well known.
  
  
  METHODS
  Between 2006 and 2015, 112 consecutive patients with CMR-based diagnosis of acute myocarditis were identified in our institution. Of them, 88 were available for clinical follow-up and represented our studied population. Patients were divided into infarct-like group (n=48) (association of acute chest pain, elevated Troponin levels and ST-elevation) and non-infarct-like group (n=40) with any other presentation. The composite primary endpoint of major cardiovascular events (MACE) included: all-cause mortality, cardiac mortality, recurrence of myocarditis, heart failure, and sustained ventricular tachycardia.
  
  
  RESULTS
  During follow-up, 21 patients (24%) experienced MACE and infarct-like patients were significantly more at risk for MACE than non-infarct-like patients (HR 2.4, 95% CI [1.01-5.80] p=0.04). Infarct-like patients exhibited in particular a higher risk of sustained ventricular tachycardia and recurrence of myocarditis (p=0.03). They had lower CMR-derived left (p=0.03) and right (p=0.001) ventricular ejection fractions, and exhibited larger areas of late gadolinium enhancement (LGE) (p=0.001). In multivariate analysis, both initial NYHA functional class >II and LGE mass were independent predictors for long-term MACE occurrence (HR 5.8 and 1.07 per gram respectively, p=0.007). Moreover, a threshold of LGE mass >17g provided a high discrimination for MACE occurrence (AUC of 0.81).
  
  
  CONCLUSIONS
  The infarct-like pattern of acute myocarditis is associated with MACE occurrence. Initial NYHA functional class >II and LGE are independent predictive factors of MACE during long-term follow-up after acute myocarditis.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Houzefa
authors.initials: H
authors.lastname: Chopra
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Arangalage
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Zarka
authors.affiliation: Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Villejuif, 94805, France; CESP Centre for Research in Epidemiology and Population Health, INSERM U1018 (Team 2, Methodology and clinical epidemiology in molecular oncology), Université Paris-Sud, Villejuif 94805, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Fayard
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chillon
authors.affiliation: Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Henry-Feugeas
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France; INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Philippe-Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France; INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.affiliation: Faculté de Médecine, Paris-Diderot University, Paris, France; DHU Fire, Paris-Diderot University, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148 Bichat Hospital, Paris, France. Electronic address: phalla.ou@aphp.fr.
authors.forename: Phalla
authors.initials: P
authors.lastname: Ou
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute myocarditis; Cardiac magnetic resonance imaging; Infarct-like; Late gadolinium enhancement; Outcome