ACUTE MYOCARDITIS IN THE MAGNETIC RESONANCE IMAGING ERA: PATIENT’S CHARACTERISTICS AND MID-TERM FOLLOW-UP.

Resumo

Background: Myocarditis is an inflammation of myocardial tissue that presents with a wide range of symptoms. Cardiovascular magnetic resonance (CMR) has become the first choice of non-invasive assessment of myocardial inflammation in suspected pts. Aims: The aim of this study was to report clinical, paraclinical and follow up data observed in pts with acute myocarditis confirmed by CMR in a single center.  Methods: We retrospectively studied27 pts admitted for acute myocarditis between November 2010 and November 2012. All pts had ECG, echocardiography and CMR. Ultrasensitive cardiac troponin and CRP were measured. Coronary angiogram was performed in case of acute myocardial infarction-like syndrome or in the presence of CV risk factors. We reviewed the files of the hospital out-patient clinic and contacted the pts or their cardiologists by phone for those followed outside the hospital. Results: There were 23 males (85.2%) and 4 females, aged 36 ± 19 yrs. ST elevation was found in17 pts (62.9%). All had elevated cardiac troponin. Echocardiography showed abnormalities of wall motion in16 pts (59.2%). Mean LVEF on CMR was 53.96 ± 9.9% and late gadolinium enhancement was in lateral in 80%, in inferior in 10% and anterior or apical wall in 10%. Coronary angiogram was normal, performed in14 pts (51.8%). Complications included VT in4 pts (14.8 %), AF in 2, and cardiac tamponade in 1. Follow-up was obtained for23 pts (85%).One died for pulmonary embolism on lung cancer. All others had a favorable evolution. Conclusion: Our study showed that myocarditis affects in majority young and male patients. CMR appears as the main modality of diagnosis. Coronary angiogram is mandatory in case of CV risk factors and/or myocardial infarction-like presentation. Evolution is often favorable. Optimal medical therapy is still to be defined. Pts can be considered as cured in the absence of chest pain and in case of normalization of echocardiography and/or CMR at follow-up.