Left Ventricular Mass with Delayed Enhancement as a Predictor of Major Events in Patients with Myocarditis with Preserved Ejection Fraction
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Biohumoral Evaluation
2.3. Transthoracic Echocardiography
2.4. Cardiac Magnetic Resonance
2.5. Late Gadolinium Enhancement Quantification
2.6. Follow-Up Evaluation
2.7. Statistical Methods
3. Results
3.1. Baseline Features
3.2. Biochemical Findings
3.3. Baseline Echocardiographic Findings
3.4. Cardiac Magnetic Resonance Findings
3.5. Events at Follow-up
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AMpEF | acute myocarditis with preserved ejection fraction |
CMR | cardiac magnetic resonance |
DE-LVM | delayed enhancement-left ventricular mass |
HF | heart failure |
LGE | late gadolinium enhancement |
LV | left ventricular |
LVEF | left ventricular ejection fraction |
NYHA | New York Heart Association |
TAPSE | tricuspid annular plane systolic excursion |
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Whole Population (n = 61) | No CV Events (n = 54) | Composite CV Event (n = 7) | p Value | |
---|---|---|---|---|
Baseline features | ||||
Age (years) | 39 ± 12 | 38 ± 12 | 44 ± 9 | 0.175 |
Sex (male) | 49 (80) | 42 (78) | 7 (100) | 0.327 |
Hypertension, n (%) | 15 (25) | 14 (26) | 1 (14) | 0.588 |
Dyslipidemia, n (%) | 13 (21) | 11 (20) | 1 (14) | 0.670 |
Diabetes, n (%) | 1 (2) | 0 (0) | 1 (14) | 0.130 |
Smoking habit, n (%) | 19 (31) | 17 (31) | 2 (29) | 0.661 |
Body mass index (kg/m2) | 25.2 ± 3.6 | 25.3 ± 3.8 | 24.6 ± 1.2 | 0.702 |
Prior myocarditis, n (%) | 4 (7) | 4 (7) | 0 (0) | 0.506 |
Laboratory findings | ||||
C reactive protein (mg/dL) | 1.96 (0.62–5.42) | 1.96 (0.62–5.87) | 2.35 (0.80–3.40) | 0.798 |
WBC (cells/mmc) | 8792 ± 2681 | 8824 ± 2766 | 8530 ± 2137 | 0.813 |
Neutrophils (%) | 63 ± 11 | 61 ± 11 | 76 ± 7 | 0.014 |
Hs-troponin (ng/L) | 648 (251–1555) | 710 (264–1583) | 473 (90–1843) | 0.677 |
Serum creatinine (mg/dL) | 0.92 ± 0.12 | 0.91 ± 0.11 | 0.97 ± 0.15 | 0.452 |
GOT (UI/L) | ||||
Baseline echocardiographic findings | ||||
Baseline LVEF (%) | 57 ± 3 | 57 ± 3 | 56 ± 2 | 0.459 |
IVS (mm) | 9.9 ± 1.3 | 9.9 ± 1.3 | 10.0 ± 2.0 | 0.882 |
TAPSE (mm) | 23 ± 4 | 23 ± 3 | 26 ± 7 | 0.049 |
sPAP (mmHg) | 26 ± 5 | 25 ± 5 | 25 ± 5 | 0.798 |
Cardiac magnetic resonance findings | ||||
Indexed LVEDV (mL/m2) | 80 ± 14 | 80 ± 14 | 81 ± 15 | 0.970 |
Indexed LVM (g/m2) | 75 ± 13 | 75 ± 13 | 74 ± 16 | 0.974 |
LVEF (%) | 62 ± 5 | 62 ± 5 | 61 ± 8 | 0.666 |
Indexed RVEDV (mL/m2) | 63 (58–75) | 63 (58–75) | 59 (53–68) | 0.367 |
RVEF (%) | 57 ± 8 | 57 ± 8 | 58 ± 8 | 0.876 |
Presence of myocardial edema, n (%) | 30 (49) | 26 (48) | 4 (57) | 0.707 |
IVS edema, n (%) | 14 (23) | 12 (22) | 2 (29) | 0.655 |
Lateral/inferolateral edema, n (%) | 15 (25) | 13 (24) | 2 (29) | 0.795 |
Inferior edema, n (%) | 7 (12) | 6 (11) | 1 (14) | 0.804 |
Anterior edema, n (%) | 9 (15) | 8 (15) | 1 (14) | 0.970 |
DE, n (%) | 57 (93) | 52 (96) | 5 (71) | 0.012 |
IVS DE, n (%) | 16 (26) | 14 (26) | 2 (29) | 0.881 |
Lateral/inferolateral DE, n (%) | 44 (72) | 40 (74) | 4 (57) | 0.386 |
Inferior DE, n (%) | 14 (23) | 11 (20) | 3 (43) | 0.335 |
Anterior DE, n (%) | 7 (12) | 7 (13) | 0 (0) | 0.586 |
Number of segments with DE, n | 2.0 ± 1.7 | 2.0 ± 1.4 | 1.9 ± 1.5 | 0.813 |
DE-LVM (g) | 12 (8–17) | 12 (8–16) | 18 (14–29.5) | 0.028 |
DE-LVM/LVM, % | 7.9 (6.4–11.7) | 7.7 (6.2–11.6) | 11.3 (9.9–19.9) | 0.047 |
Follow-up | ||||
Echocardiographic LVEF (%) | 57 ± 4 | 57 ± 5 | 55 ± 2 | 0.261 |
B | HR | CI (95%) | p Value | |
---|---|---|---|---|
Age | 0.049 | 1.050 | 0.985–1.120 | 0.131 |
C reactive protein | −0.138 | 0.872 | 0.639–1.189 | 0.386 |
Neutrophils | 0.010 | 1.010 | 0.962–1.061 | 0.677 |
Hs-troponin | 0.045 | 1.045 | 0.979–1.028 | 0.860 |
sPAP | 0.006 | 1.006 | 0.811–1.248 | 0.957 |
LVEF | −0.017 | 0.983 | 0.850–1.136 | 0.814 |
RVEF | 0.010 | 1.010 | 0.909–1.122 | 0.856 |
IVS DE | −0.123 | 0.884 | 0.171–4.583 | 0.884 |
DE-LVM | 0.122 | 1.130 | 1.017–1.256 | 0.022 |
DE-LVM/LVM | 4.573 | 2.132 | 1.272–3.573 | 0.018 |
Whole Population (n = 61) | DE-LVM below Median Value (n = 31) | DE-LVM above Median Value (n = 30) | p Value | |
---|---|---|---|---|
Baseline features | ||||
Age (years) | 39 ± 12 | 38 ± 12 | 38 ± 10 | 0.175 |
Sex (male) | 49 (80) | 21 (68) | 28 (93) | 0.327 |
Hypertension, n (%) | 15 (25) | 9 (29) | 6 (20) | 0.592 |
Dyslipidemia, n (%) | 13 (21) | 7 (23) | 6 (20) | 0.856 |
Diabetes, n (%) | 1 (2) | 0 | 1 (3) | 0.130 |
Smoking habit, n (%) | 19 (31) | 11 (35) | 8 (27) | 0.948 |
Body mass index (kg/m2) | 25.2 ± 3.6 | 25.0 ± 3.8 | 25.5 ± 3.5 | 0.418 |
Prior myocarditis, n (%) | 4 (7) | 2 (6) | 2 (7) | 0.506 |
Laboratory findings | ||||
C reactive protein (mg/dL) | 1.96 (0.62–5.42) | 1.82 (0.45–4.35) | 2.70 (0.67–7.00) | 0.775 |
WBC (cells/mmc) | 8792 ± 2681 | 8794 ± 2823 | 8738 ± 2753 | 0.813 |
Neutrophils (%) | 63 ± 11 | 59 ± 11 | 64 ± 11 | 0.014 |
Hs-troponin (ng/L) | 648 (251–1555) | 396 (195–1055) | 720 (355–1915) | 0.669 |
Serum creatinine (mg/dL) | 0.92 ± 0.12 | 0.91 ± 0.11 | 0.93 ± 0.13 | 0.452 |
GOT (UI/L) | 27 (18–54) | 20 (16–29) | 40 (23–71) | 0.296 |
Baseline echocardiographic findings | ||||
Baseline LVEF (%) | 57 ± 3 | 57 ± 3 | 57 ± 3 | 0.459 |
IVS (mm) | 9.9 ± 1.3 | 9.4 ± 1.1 | 10.3 ± 1.4 | 0.882 |
TAPSE (mm) | 23 ± 4 | 24 ± 4 | 23 ± 4 | 0.049 |
sPAP (mmHg) | 26 ± 5 | 25 ± 3 | 26 ± 6 | 0.798 |
Cardiac magnetic resonance findings | ||||
Indexed LVEDV (mL/m2) | 80 ± 14 | 78 ± 11 | 83 ± 15 | 0.970 |
Indexed LVM (g/m2) | 75 ± 13 | 69 ± 9 | 81 ± 14 | 0.974 |
LVEF (%) | 62 ± 5 | 63 ± 5 | 61 ± 5 | 0.666 |
Indexed RVEDV (mL/m2) | 63 (58–75) | 62 (57–68) | 66 (60–75) | 0.321 |
RVEF (%) | 57 ± 8 | 57 ± 9 | 57 ± 7 | 0.876 |
Presence of myocardial edema, n (%) | 30 (49) | 11 (35) | 19 (63) | 0.707 |
IVS edema, n (%) | 14 (23) | 5 (16) | 9 (30) | 0.655 |
Lateral/inferolateral edema, n (%) | 15 (25) | 4 (13) | 11 (37) | 0.795 |
Inferior edema, n (%) | 7 (12) | 3 (10) | 4 (13) | 0.804 |
Anterior edema, n (%) | 9 (15) | 5 (16) | 4 (13) | 0.971 |
DE, n (%) | 57 (93) | 27 (87) | 30 (100) | 0.061 |
IVS DE, n (%) | 16 (26) | 5 (16) | 11 (37) | 0.882 |
Lateral/inferolateral DE, n (%) | 44 (72) | 22 (70) | 22 (73) | 0.386 |
Inferior DE, n (%) | 14 (23) | 6 (19) | 8 (27) | 0.335 |
Anterior DE, n (%) | 7 (12) | 3 (10) | 4 (13) | 0.586 |
Number of segments with DE, n | 2.0 ± 1.7 | 1.4 ± 0.6 | 2.7 ± 1.4 | 0.813 |
DE-LVM/LVM, % | 7.9 (6.4–11.7) | 6.3 (4.9–7.7) | 11.3 (8.1–12.8) | <0.001 |
Follow-up | ||||
Echocardiographic LVEF (%) | 57 ± 4 | 58 ± 3 | 57 ± 6 | 0.070 |
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Ghionzoli, N.; Gismondi, A.; Mandoli, G.E.; Spera, L.; Di Florio, A.; D’Ascenzi, F.; Cameli, M.; Cavigli, L.; Sciaccaluga, C.; Carbone, S.F.; et al. Left Ventricular Mass with Delayed Enhancement as a Predictor of Major Events in Patients with Myocarditis with Preserved Ejection Fraction. J. Clin. Med. 2022, 11, 6082. https://doi.org/10.3390/jcm11206082
Ghionzoli N, Gismondi A, Mandoli GE, Spera L, Di Florio A, D’Ascenzi F, Cameli M, Cavigli L, Sciaccaluga C, Carbone SF, et al. Left Ventricular Mass with Delayed Enhancement as a Predictor of Major Events in Patients with Myocarditis with Preserved Ejection Fraction. Journal of Clinical Medicine. 2022; 11(20):6082. https://doi.org/10.3390/jcm11206082
Chicago/Turabian StyleGhionzoli, Nicolò, Annalaura Gismondi, Giulia Elena Mandoli, Lucia Spera, Alex Di Florio, Flavio D’Ascenzi, Matteo Cameli, Luna Cavigli, Carlotta Sciaccaluga, Salvatore Francesco Carbone, and et al. 2022. "Left Ventricular Mass with Delayed Enhancement as a Predictor of Major Events in Patients with Myocarditis with Preserved Ejection Fraction" Journal of Clinical Medicine 11, no. 20: 6082. https://doi.org/10.3390/jcm11206082