Patterns of cardiovascular magnetic resonance inflammation in acute myocarditis from South Asia and Middle East

Abdel-Nasser Ghareeb; Sabir A Karim; Vivek P Jani; Willington Francis; Jef Van den Eynde; Maryam Alkuwari; Shelby Kutty

doi:10.1016/j.ijcha.2022.101029

Patterns of cardiovascular magnetic resonance inflammation in acute myocarditis from South Asia and Middle East

Int J Cardiol Heart Vasc. 2022 Apr 8:40:101029. doi: 10.1016/j.ijcha.2022.101029. eCollection 2022 Jun.

Authors

Abdel-Nasser Ghareeb¹, Sabir A Karim¹, Vivek P Jani², Willington Francis¹, Jef Van den Eynde^{2

3}, Maryam Alkuwari¹, Shelby Kutty²

Affiliations

¹ Department of Clinical Imaging, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
² Helen B. Taussig Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA.
³ Department of Cardiovascular Sciences, KU Leuven, Belgium.

Abstract

Background: Cardiovascular magnetic resonance (CMR) is the test of choice for diagnosis and risk stratification of myocardial inflammation in acute viral myocarditis. The objective of this study was to assess patterns of CMR inflammation in a cohort of acute myocarditis patients from Northern Africa, Asia, and the Middle East using unsupervised machine learning.

Methods: A total of 169 racially and ethnically diverse adults ( $\geq$ 18 years of age) with CMR confirmed acute myocarditis were studied. The primary outcome was a combined clinical endpoint of cardiac death, arrhythmia, and dilated cardiomyopathy. Machine learning was used for exploratory analysis to identify patterns of CMR inflammation.

Results: Our cohort was diverse with 25% from Northern Africa, 33% from Southern Asia, and 28% from Western Asia/the Middle East. Twelve patients met the combined clinical endpoint - 3 had arrythmia, 8 had dilated cardiomyopathy, and 1 died. Patients who met the combined endpoint had increased anterior (p = 0.034) and septal (p = 0.042) late gadolinium enhancement (LGE). Multivariable logistic regression, adjusted for age, gender, and BMI, found that patients from Southern Asia (p = 0.041) and the Middle East (p = 0.043) were independently associated with lateral LGE. Unsupervised machine learning and factor analysis identified two distinct CMR patterns of inflammation, one with increased LGE and the other with increased myocardial T1/T2.

Conclusions: We found that anteroseptal inflammation is associated with worsened outcomes. Using machine learning, we identified two patterns of myocardial inflammation in acute myocarditis from CMR in a racially and ethnically diverse group of patients from Southern Asia, Northern Africa, and the Middle East.

Keywords: BSA, Body Surface Area; CMR, Cardiovascular Magnetic Resonance; CMV, Cytomegalovirus; CRP, C Reactive Protein; Cardiovascular magnetic resonance; DALY, Disability-Adjusted Life Years; EBV, Epstein-Barr Virus (EBV); EGE, Early Gadolinium Enhancement; EMB, Endomyocardial Biopsy; Global health; HBV, Hepatitis B Virus; Hs, High-Sensitivity; IQR, interquartile range; LGE, Late Gadolinium Enhancement; LLC, Lake Louise Criteria; LVEDVi, Left Ventricular End Diastolic Volume indexed; LVEF, Left Ventricular Ejection Fraction; LVESVi, Left Ventricular End Systolic Volume indexed; Machine learning; RVEF, Right Ventricular Ejection Fraction; SD, Standard Deviation; T1, Spin-lattice relaxation; T1/T2 parametric mapping; T2, Transverse relaxation; Viral myocarditis.

Grants and funding

T32 GM136577/GM/NIGMS NIH HHS/United States