The pattern of late gadolinium enhancement by cardiac MRI in fulminant myocarditis and its prognostic implication: a two-year follow-up study

Luying Jiang; Houjuan Zuo; Jingbo Liu; Jianyu Wang; Kaiyue Zhang; Chunran Zhang; Xiangyang Peng; Yujian Liu; Daowen Wang; Haojie Li; Hong Wang

doi:10.3389/fcvm.2023.1144469

The pattern of late gadolinium enhancement by cardiac MRI in fulminant myocarditis and its prognostic implication: a two-year follow-up study

Front Cardiovasc Med. 2023 Jun 27:10:1144469. doi: 10.3389/fcvm.2023.1144469. eCollection 2023.

Authors

Luying Jiang^#^{1

2

3}, Houjuan Zuo^#^{1

2}, Jingbo Liu^{1

2}, Jianyu Wang^{1

2}, Kaiyue Zhang^{1

2}, Chunran Zhang^{1

3}, Xiangyang Peng^{1

2

3}, Yujian Liu^{1

2}, Daowen Wang^{1

2}, Haojie Li^{1

2

4}, Hong Wang^{1

2}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, China.
³ The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi University, Shihezi, China.
⁴ Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

^# Contributed equally.

Abstract

Background: Myocardial fibrosis, as quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), provides valuable prognostic information for patients with myocarditis. However, due to the low incidence rate of fulminant myocarditis (FM) and accordingly small sample size, the knowledge about the role of LGE to patients with FM is limited.

Methods and results: A total of 44 adults with viral-FM receiving the Chinese treating regimen were included in this retrospective study. They were divided into the low LGE group and the high LGE group according to the ratio of LGE to left ventricular mass (LGE mass%). CMR exams and LGE were performed after hemodynamic assistance at discharge in all patients with FM. Routine echocardiography parameters and global longitudinal strain (GLS) at discharge and at 2-year follow-up were obtained and then compared. Both left ventricular ejection fraction (LVEF) and GLS showed no significant difference in both groups at discharge, whereas significant differences were observed at 2-year follow-up between two groups. Moreover, there were significant improvements of LVEF and GLS in the low LGE group, but not in the high LGE group during the 2-year period. Furthermore, LGE mass% was negatively correlated with GLS and LVEF.

Conclusions: There were two distinct forms of LGE presentation in patients with FM. Moreover, the cardiac function of patients with low LGE was significantly better than those with high LGE at 2-year follow-up. LGE mass% at discharge provided significant prognosis information about cardiac function of patients with FM.

Keywords: follow-up study; fulminant myocarditis; global longitudinal strain; late gadolinium enhancement; left ventricular function.

Grants and funding

The project was supported by a grant from the Natural Science Foundation of China (grant no. 81873535) and the Natural Science Foundation of Hubei Province (grant no. 2020CFB573).