2 - Acute-phase transmural LGE is associated with impaired functional recovery in pediatric myocarditis

Friday, February 14, 2020

11:19 AM – 11:28 AM

Location: Salon J2

Background: Myocarditis is a heterogeneous disease in terms of presentation and outcomes. In the current era mortality is relatively low with high rates of recovery of ventricular function, up to 70% in some series. The presence of late gadolinium enhancement (LGE) has previously been associated with worse prognosis. We intend to assess the prognostic value various acute-phase CMR markers in pediatric myocarditis.

Methods: Historical cohort study of pediatric patients undertaking cardiac magnetic resonance (CMR) for suspected myocarditis at two tertiary European centers from March 2007 to April 2019. All patients underwent standard CMR protocols including T2 weighted sequences and LGE assessment. Follow-up data were retrieved from patient records and subsequent CMR evaluations. Functional recovery was defined as the first record of normal biventricular volumes and systolic function without region wall motion abnormalities, either by echo or CMR.

Results: 125 patients were analyzed, with a mean age of 10,8 years. LGE was found in 77% of the acute phase CMR, fulfilling Lake Louise criteria in 76,4% of cases. An average of 4,2 segments were found to be affected. The most common LGE pattern found was subepicardial, present in 78% of LGE+ cases, followed by intramural (32%) and transmural (19%). Average follow-up time was 745 days and mortality was 2,4%. Functional recovery was observed in 86,3% of cases, most occurring during the first year of follow-up (79,0% at 1 year). Acute-phase LGE was associated with impaired recovery, (HR 0,60 p =,049). The number of affected segments and presence of transmural LGE further increased the strength of this association, with a HR for recovery of 0,90 per segment and 0,17, respectively (p 0,03 for both univariate analyses). LVEDV, LVEF and RVEF were also statistically significant associations. Upon multivariate analysis, the most significant CMR predictors of recovery were LVEF (HR 1,06 p 0,006) and transmural LGE (HR 0,09 p 0,012).

Conclusion: The presence of transmural LGE upon acute-phase CMR was associated with impaired functional recovery in pediatric myocarditis.

Presenting Author(s)

DM

Duarte Martins, MD, MSc

Paediatric Cardiolgist
Hospital Santa Cruz

Disclosure: Disclosure information not submitted.

Primary Author(s)

DM

Duarte Martins, MD, MSc

Paediatric Cardiolgist
Hospital Santa Cruz

Disclosure: Disclosure information not submitted.

Co-Author(s)

LA

Lamia Ait-Ali, MD, PhD

Italian National Research Council | CNR

Disclosure: Disclosure information not submitted.
GA

Giovanni Aquaro, MD

Cardiologist
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.
YB

Yasmine Benadjaoud

Hôpital Necker Enfants Malades, Paris

Disclosure: Disclosure information not submitted.
NM

Nicola Martini

Italian National Research Council | CNR

Disclosure: Disclosure information not submitted.
AB

Andrea Barison, MD, PhD

Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.
DK

Diala Khraische

Hopital Necker Enfants Malades, Paris

Disclosure: Disclosure information not submitted.
NB

Nathalie Boddaert, MD, PhD

Hopital Necker Enfants Malades, Paris

Disclosure: Disclosure information not submitted.
PF

Pierluigi Festa, MD

Fondazione G. Monasterio CNR Regione Toscana

Disclosure: Disclosure information not submitted.
DB

Damien Bonnet, MD, PhD

Hopital Necker Enfants Malades, Paris

Disclosure: Disclosure information not submitted.
Fracesca Raimondi, MD

Lead of Non Invasive Cardiac Imaging CT scan and cardiac MRI
Hopital Necker Enfants Malades

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.