Background: Acute Myocarditis (AM) is an inflammatory process affecting the heart. Clinical features can range from an asymptomatic disease to severe heart failure. The causes that stand behind the wide spectrum of clinical presentations and outcomes of AM are not clear.
Objectives: This study aimed to assess the relationship between left ventricle dysfunction (LVD) as assessed by echocardiography and cardiac Magnetic resonance imaging (CMR) and several clinical features including myocardial biomarkers and ECG.
Methods: The study cohort consisted of 42 patients (83% male) with confirmed AM recruited from January 2009 to December 2012. Mean age was 32 ±12.6 years.
Results: Echo findings of LVD were observed in 10 patients (24%) while right ventricular dysfunction (RVD) was seen in one patient. The most common ECG finding consisted of ST segment elevation involving the inferior leads. No relationship was found between LVD, gender, age, fever and the extent of ST segment deviation. No relationship was found between biomarker`s levels and LVD. Based on CMR, LVD was related to the extent of tissue edema (r=-0.44; p=0.02) but not to late gadolinium enhancement [(LGE) r=-0.18; p=0.248]. LVD by echo correlated with the CMR counterpart findings (r=-0.52; p<0.001). CMR findings of RVD were observed in 11 patients in comparison to Echo (r=-0:47; P<0.002). There was a significant statistical relationship between LVD and RVD (r=-0:52; p<0:001) based on CMR.
Conclusions: No clinical predictors for LVD were observed in this cohort. Apart from an objective evidence of late enhancement, CMR gave evidence that tissue edema is well correlated with the severity of LVD. In addition, RVD in AM patients seems to be underestimated using conventional echo as compared to CMR. Therefore, the employment of CMR can help to identify hidden findings of RVD which may play a clinical and prognostic role in AM. The impact of our findings on the long term outcome, still need to be investigated.
