Predictive Value of Left Ventricular Systolic Dysfunction or Wall Motion Abnormalities for Non-Ischemic Myocardial...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Myocardial Diseases

Background:

• Left ventricular (LV) systolic dysfunction, encompassing reduced ejection fraction (LVEF) and regional wall motion abnormalities (RWMA), is crucial in cardiovascular disease assessment.
• Myocarditis, an inflammation of the heart muscle, can lead to non-ischemic myocardial injury, characterized by fibrosis or scar tissue.
• Assessing LV systolic dysfunction is vital for predicting myocardial damage in patients with suspected myocarditis.

Purpose of the Study:

• To evaluate the predictive value of LV systolic dysfunction for non-ischemic myocardial injury in patients with suspected myocarditis.
• To determine if parameters like LVEF and RWMA can identify myocardial fibrosis on cardiac magnetic resonance (CMR).
• To establish imaging biomarkers for non-ischemic myocardial damage in this patient cohort.

Main Methods:

• A multicenter, observational, retrospective study included 773 stable outpatients with suspected myocarditis from 2018-2021.
• Contrast-enhanced CMR was used to assess LV systolic function (LVEF, RWMA) and late gadolinium enhancement (LGE) indicative of myocardial fibrosis.
• Patients with prior cardiovascular disorders were excluded, focusing the analysis on suspected myocarditis.

Main Results:

• Of 773 patients, 12% (95) had LV systolic dysfunction. Among 456 patients with confirmed non-ischemic LGE, 28% had RWMA and 18% had LVEF < 50%.
• The median LGE involved 3 LV segments, constituting 6% of LV mass.
• Wall motion score index > 1 (AUC 0.62) and LVEF < 56% (AUC 0.59) were significant predictors of non-ischemic myocardial injury.

Conclusions:

• In stable patients with suspected myocarditis, the presence of any RWMA is a valuable predictor of non-ischemic myocardial injury.
• An LVEF < 56% also demonstrated predictive value for myocardial fibrosis as assessed by CMR.
• These LV systolic function parameters can aid in identifying myocardial damage in suspected myocarditis cases.