title: Abnormal T2 mapping cardiovascular magnetic resonance correlates with adverse clinical outcome in patients with suspected acute myocarditis.
abstract: BACKGROUND
  While most patients recover from suspected acute myocarditis (sAMC) some develop progressive disease with 5-year mortality up to 20%. Recently, parametric Cardiovascular Magnetic Resonance (CMR) approaches, quantifying native T1 and T2 relaxation time, have demonstrated the ability to increase diagnostic accuracy. However, prognostic implications of T2 values in this cohort are unknown. The purpose of the study was to investigate the prognostic relevance of elevated CMR T2 values in patients with sAMC.
  
  
  RESULTS
  We carried out a prospective study in 46 patients with sAMC defined by current ESC recommendations. A combined endpoint was defined by the occurrence of at least one major adverse cardiac event (MACE) and hospitalisation for heart failure. Event rate was 24% (n = 11) for 1-year-MACE and hospitalisation. A follow-up after 11 ± 7 months was performed in 98% of the patients. Global T2 values were significantly increased at acute stage of disease compared to controls and decreased over time. During acute disease, elevated global T2 time (odds ratio 6.3, p < 0.02) as well as myocardial fraction with T2 time >80 ms (odds ratio 4.9, p < 0.04) predicted occurrence of the combined endpoint. Patients with clinical recovery revealed significantly decreased T2 relaxation times at follow-up examinations; however, T2 values were still elevated compared to healthy controls.
  
  
  CONCLUSIONS
  Assessment of myocardial T2 relaxation times at initial presentation facilitates CMR-based risk stratification in patients with acute myocarditis. T2 Mapping may emerge as a new tool to monitor inflammatory myocardial injuries during the course of disease.
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Spieker
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haberkorn
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Gastl
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Behm
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Stratis
authors.initials: S
authors.lastname: Katsianos
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Horn
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Jacoby
authors.affiliation: Philips Healthcare, Hamburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.affiliation: Institute of Pathology, Heinrich Heine University, Duesseldorf, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinecke
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.|CARID, Cardiovascular Research Institute Düsseldorf, Duesseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Westenfeld
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. Florian.Boenner@med.uni-duesseldorf.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Bönner
mesh_terms: D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Myocarditis; Prognostic implication; T2 Mapping