title: Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis.
abstract: BACKGROUND
  The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology.
  
  
  METHODS
  We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients.
  
  
  RESULTS
  Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p<0.0001) with a relative reduction of 42% compared with baseline. Patients showing increased LV-ESVi at follow up had a lower decrease of LGE% (p=0.038).
  
  
  CONCLUSIONS
  In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy. Electronic address: enrico.ammirati@ospedaleniguarda.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.affiliation: Cardiothoracic Department, San Raffaele Hospital and Vita Salute University, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Moroni
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy; Health Science Department, Bicocca University, Milano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Sormani
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Peritore
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Milazzo
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Quattrocchi
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Manlio
authors.initials: M
authors.lastname: Cipriani
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy; Health Science Department, Bicocca University, Milano, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannattasio
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Roghi
authors.affiliation: Cardiothoracic Department, San Raffaele Hospital and Vita Salute University, Milano, Italy. Electronic address: camici.paolo@hsr.it.
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Camici
authors.affiliation: "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pedrotti
mesh_terms: D000208:Acute Disease; D000328:Adult; D003287:Contrast Media / Q000494:pharmacology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D009942:Organometallic Compounds / Q000494:pharmacology*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D005682:Gadolinium
keywords: Acute myocarditis; Cardiac magnetic resonance; Fulminant myocarditis; Late gadolinium enhancement