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Prognostic Implications of Clinical and Imaging Diagnostic Criteria for Myocarditis

Benedikt Bernhard1, Martin E Marxer2, Jan C Zurkirchen2

  • 1Department of Cardiology, University Hospital Bern, Bern, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Journal of the American College of Cardiology
|October 2, 2024
PubMed

Insights

The European Society of Cardiology (ESC) criteria are effective for diagnosing myocarditis and predicting patient outcomes. Updated Lake-Louise criteria (LLC) also show prognostic value, highlighting the importance of clinical and cardiac MRI findings.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Cardiac Imaging

Background:

  • Current diagnostic criteria for myocarditis vary among major cardiology societies.
  • The prognostic implications of these differing criteria have not been previously compared.

Purpose of the Study:

  • To compare the diagnostic and prognostic value of European Society of Cardiology (ESC) criteria, updated Lake-Louise criteria (LLC), American Heart Association (AHA) probable acute myocarditis (pAM) criteria, and expert consensus criteria for acute myocarditis (AM) and complicated myocarditis (CM).

Main Methods:

  • A cohort of 1,050 patients with suspected myocarditis and available cardiac magnetic resonance (CMR) data were analyzed.
  • Patients without alternative diagnoses were assessed for adherence to various myocarditis diagnostic criteria.
  • The association between diagnostic criteria and adverse composite outcomes (heart failure hospitalization, recurrent myocarditis, sustained ventricular tachycardia, or death) was evaluated.

Main Results:

  • Most patients (89.3%) met ESC criteria, while fewer met LLC (28.5%), pAM (33.9%), AM (20.6%), or CM (7.3%).
  • Adverse events occurred in 15.3% of patients over a median follow-up of 3.4 years.
  • ESC criteria and LLC demonstrated the strongest independent and incremental prognostic value for adverse outcomes, with LLC showing the highest event rates (6.6%).

Conclusions:

  • ESC criteria identify a larger proportion of myocarditis patients in a real-world setting compared to LLC.
  • Both ESC and LLC criteria possess significant independent prognostic value.
  • Integrating clinical assessment (ESC criteria) with CMR findings (LLC) is crucial for accurate myocarditis diagnosis and risk stratification.
Abstract

Keywords:
Lake Louise criteriacardiac magnetic resonancediagnostic criteriamyocarditis

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