title: Myocardial fibrosis detected with Gadolinium Delayed Enhancement in Cardiac Magnetic Resonance Imaging and Ventriculoarterial Coupling alterations in patients with Acute Myocarditis.
abstract: BACKGROUND
  The delayed Gadolinium Myocardium Enhancement (DGE) extent on Cardiac Magnetic Resonance (CMR) correlates with biomarkers of myocardial injury in patients with acute viral myocarditis and is an independent predictor of adverse cardiovascular outcome. Ventriculoarterial Coupling (VAC) is related to both the cardiovascular work output and energy efficiency and can be noninvasively assessed. In this work, we aimed to evaluate alterations in VAC indices in correlation with DGE in patients with acute myocarditis.
  
  
  METHODS
  Fifty-seven patients (mean age 42 (18) years old, 58% male, 19% had hypertension, 9% coronary artery disease and 2% diabetes mellitus) with diagnosed acute myocarditis were enrolled. All patients underwent comprehensive echocardiographic evaluation with a VAC value calculation and CMR imaging within a 24-hour period.
  
  
  RESULTS
  The mean ejection fraction was 42±18%; 49% had preserved systolic function. DGE was noted in 56% of patients. When stratified by EF (preserved or reduced), those with an EF>50% had significantly smaller ventricles and a lower VAC, closer to the values that maximize the stroke work and energy efficiency (p=0.002 for end diastolic diameters, 0.001 for VAC, 0.01 for distance from 0.7 and 0.5 and 0.056 for distance from 1). No difference in DGE prevalence was noted (p=0.34). DGE-based stratification did not reveal any difference in the EF or VAC values between groups. Multi-adjusted regression analysis showed that EF was a significant predictor of VAC alterations.
  
  
  CONCLUSIONS
  In acute myocarditis patients, DGE is related to neither EF nor VAC; however, EF significantly affects the VAC status. Further studies are needed to investigate the potential quantitative, rather than qualitative, relationships between these variables.
authors.affiliation: First Department of Cardiology, Athens Medical School, Athens, Greece. Electronic address: chrysohoou@usa.net.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: First Department of Cardiology, Athens Medical School, Athens, Greece.
authors.forename: Christos Konstantinos
authors.initials: CK
authors.lastname: Antoniou
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Stillman
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Osalewa
authors.initials: O
authors.lastname: Lalude
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Henry
authors.affiliation: Emory University Hospital, Atlanta, GA, USA.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005682:Gadolinium / Q000378:metabolism*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D005682:Gadolinium
keywords: Cardiac magnetic resonance imaging; Myocarditis; Ventriculoarterial coupling