title: Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: clinical and prognostic implications.
abstract: The pathophysiologic mechanisms and the prognostic meaning of electrocardiographic (ECG) T-wave inversion (TWI) occurring in a subgroup of patients with clinically suspected acute myocarditis remain to be elucidated. Contrast-enhanced cardiac magnetic resonance (CMR) offers the potential to identify myocardial tissue changes such as edema and/or fibrosis which may underlie TWI.
  
  
  
  We studied 76 consecutive patients (median age 34years) with clinically suspected acute myocarditis, using a comprehensive CMR protocol which included T2 weighted sequences for myocardial edema. At the time of CMR, TWI was observed in 21 (27%) patients. There was a statistically significant association of TWI with the median number of left ventricular (LV) segments showing both any pattern of myocardial edema (transmural and non-transmural) [5 (3-7) vs. 3 (2-4); p=0.015] and myocardial late-gadolinium-enhancement [4 (3-7) vs. 3 (2-4); p=0.002]. Transmural myocardial edema involving ≥2 LV segments was found in 17/21 (81%) patients with TWI versus 13/55 (24%) patients without TWI (p<0.001) and remained the only independent predictor of TWI at multivariable analysis (OR=9.96; 95%CI=2.71-36.6; p=0.001). Overall, topographic concordance between the location of TWI across the ECG leads and the regional distribution of transmural myocardial edema was 88%. There was no association between acute TWI and reduced LV ejection fraction (<55%) at 6-months of follow-up.
  
  
  
  This is the first study to demonstrate an association between LV transmural myocardial edema as evidenced by CMR sequences and TWI in clinically suspected acute myocarditis. As an expression of reversible myocardial edema, development of TWI during the acute disease phase was not a predictor of LV systolic dysfunction at follow-up.
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: De Lazzari
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Siciliano
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Susana
authors.affiliation: Department of Radiology, University of Padova, Padova, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Giorgi
authors.affiliation: Department of Radiology, University of Padova, Padova, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Lacognata
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Perazzolo Marra
authors.affiliation: Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy. Electronic address: domenico.corrado@unipd.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D004489:Edema, Cardiac / Q000150:complications* / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Cardiac magnetic resonance imaging; Myocardial edema; Myocarditis; Negative T-waves