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Diagnostic and prognostic value of cardiac magnetic resonance in acute myocarditis: a systematic review and meta-analysis

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Abstract

While diagnostic criteria were elaborated for acute myocarditis using cardiac magnetic resonance (CMR) in 2009, studies have since examined the yield of traditional and novel CMR parameters to achieve greater accuracy and to predict clinical outcomes. The purpose of this systematic review and meta-analysis was to determine the diagnostic and prognostic value of CMR parameters for acute myocarditis. MEDLINE and EMBASE were systematically searched for original studies that reported CMR parameters in adult patients suspected of acute myocarditis. Each CMR parameter's binary prevalence, mean value and standard deviation were extracted. Parameters were meta-analyzed using a random-effects model to generate standardized mean differences. After screening 1492 abstracts, 53 studies were included encompassing 2823 myocarditis patients and 803 controls. Pooled standardized mean differences between myocarditis patients and controls were: T2 mapping time 2.26 (95% CI 1.50–3.02), extracellular volume 1.64 (95% CI 0.87–2.42), LGE percentage 1.30 (95% CI 0.95–1.64), T1 mapping time 1.18 (95% CI 0.35–2.01), T2 ratio 1.17 (95% CI 0.80–1.54), and EGE ratio 0.93 (95% CI 0.66–1.19). Prolonged T1 mapping time had the highest sensitivity (82%), pericardial effusion had the highest specificity (99%). Baseline LV dysfunction and the presence of LGE were predictive of major adverse cardiac events. The results support integration of parametric mapping criteria in the diagnostic criteria for myocarditis. The presence of baseline LV dysfunction and LGE predict patients at higher risk of adverse events.

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Acknowledgements

Sarah Blissett is grateful for support from the Western University Resident Research Career Development Funding.

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Authors and Affiliations

  1. Division of Cardiology, Azrieli Heart Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Sarah Blissett & Jonathan Afilalo

  2. Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Yehuda Chocron & Jonathan Afilalo

  3. Department of Radiology, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Bojan Kovacina

  4. McGill Integrated Cardiac Imaging Fellowship Program, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC, H3T 1E2, Canada

    Jonathan Afilalo

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Blissett, S., Chocron, Y., Kovacina, B. et al. Diagnostic and prognostic value of cardiac magnetic resonance in acute myocarditis: a systematic review and meta-analysis. Int J Cardiovasc Imaging 35, 2221–2229 (2019). https://doi.org/10.1007/s10554-019-01674-x

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