Prognostic Value of Right Ventricular Function in Patients With Suspected Myocarditis Undergoing Cardiac Magnetic Resonance.

Bernhard, Benedikt; Schnyder, Aaron; Garachemani, Davide; Fischer, Kady; Tanner, Giulin; Safarkhanlo, Yasaman; Stark, Anselm W; Schütze, Jonathan; Pavlicek-Bahlo, Maryam; Greulich, Simon; Johner, Caroline; Wahl, Andreas; Benz, Dominik C; Kwong, Raymond Y; Gräni, Christoph (2023). Prognostic Value of Right Ventricular Function in Patients With Suspected Myocarditis Undergoing Cardiac Magnetic Resonance. JACC. Cardiovascular imaging, 16(1), pp. 28-41. Elsevier 10.1016/j.jcmg.2022.08.011

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BACKGROUND

Risk-stratification of myocarditis is based on functional parameters and tissue characterization of the left ventricle (LV), whereas right ventricular (RV) involvement remains mostly unrecognized.

OBJECTIVES

In this study, the authors sought to analyze the prognostic value of RV involvement in myocarditis by cardiac magnetic resonance (CMR).

METHODS

Patients meeting the recommended clinical criteria for suspected myocarditis were enrolled at 2 centers. Exclusion criteria were the evidence of coronary artery disease, pulmonary artery hypertension or structural cardiomyopathy. Biventricular ejection fraction, edema according to T2-weighted images, and late gadolinium enhancement (LGE) were linked to a composite end point of major adverse cardiovascular events (MACE), including heart failure hospitalization, ventricular arrhythmia, recurrent myocarditis, and death.

RESULTS

Among 1,125 consecutive patients, 736 (mean age: 47.8 ± 16.1 years) met the clinical diagnosis of suspected myocarditis and were followed for 3.7 years. Signs of RV involvement (abnormal right ventricular ejection fraction [RVEF], RV edema, and RV-LGE) were present in 188 (25.6%), 158 (21.5%), and 92 (12.5%) patients, respectively. MACE occurred in 122 patients (16.6%) and was univariably associated with left ventricular ejection fraction (LVEF), LV edema, LV-LGE, RV-LGE, RV edema, and RVEF. In a series of nesting multivariable Cox regression models, the addition of RVEF (HRadj: 0.974 [95% CI: 0.956-0.993]; P = 0.006) improved prognostication (chi-square test = 89.5; P = 0.001 vs model 1; P = 0.006 vs model 2) compared with model 1 including only clinical variables (chi-square test = 28.54) and model 2 based on clinical parameters, LVEF, and LV-LGE extent (chi-square test = 78.93).

CONCLUSIONS

This study emphasizes the role of RV involvement in myocarditis and demonstrates the independent and incremental prognostic value of RVEF beyond clinical variables, CMR tissue characterization, and LV function. (Inflammatory Cardiomyopathy Bern Registry [FlamBER]; NCT04774549; CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy > Partial clinic Insel
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Bernhard, Benedikt, Fischer, Kady Anne, Safarkhanlo, Yasaman, Stark, Anselm Walter, Schütze, Jonathan, Pavlicek-Bahlo, Maryam, Johner, Caroline, Wahl, Andreas, Gräni, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-878X

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

11 Jan 2023 10:04

Last Modified:

11 Jan 2023 23:23

Publisher DOI:

10.1016/j.jcmg.2022.08.011

PubMed ID:

36599567

Uncontrolled Keywords:

cardiac magnetic resonance feature tracking inflammatory cardiomyopathy myocarditis right ventricle risk stratification

BORIS DOI:

10.48350/176803

URI:

https://boris.unibe.ch/id/eprint/176803

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