Journal Article

Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging

Blankstein, Ron, Windecker, Stephan, Kwong, Raymond Y., Reichlin, Tobias, Stark, Anselm W., Huber, Adrian T., Marggraf, Maximilian, Kaneko, Kyoichi, Aghayev, Ayaz, Guensch, Dominik P., Steigner, Michael, Fischer, Kady, Gräni, Christoph

2020

Overview

Risk stratification of myocarditis is challenging due to variable clinical presentations. Cardiovascular magnetic resonance (CMR) is the primary non-invasive imaging modality to investigate myocarditis while electrocardiograms (ECG) are routinely included in the clinical work-up. The association of ECG parameters with CMR tissue characterisation and their prognostic value were investigated in patients with clinically suspected myocarditis. Consecutive patients with suspected myocarditis who underwent CMR and ECG were analysed. Major adverse cardiovascular event (MACE) included all-cause death, hospitalisation for heart failure, heart transplantation, documented sustained ventricular arrhythmia, or recurrent myocarditis. A total of 587 patients were followed for a median of 3.9 years. A wide QRS-T angle, low voltage and fragmented QRS were significantly associated with late gadolinium enhancement. Further, a wide QRS-T angle, low voltage and prolonged QTc duration were associated with MACE in the univariable analysis. In a multivariable model, late gadolinium enhancement (HR: 1.90, 95%CI: 1.17-3.10; p = 0.010) and the ECG parameters of a low QRS voltage (HR: 1.86, 95%CI: 1.01-3.42; p = 0.046) and QRS-T-angle (HR: 1.01, 95%CI: 1.00-1.01; p = 0.029) remained independently associated with outcome. The cumulative incidence of MACE was incrementally higher when findings of both CMR and ECG were abnormal (p<0.001). In patients with clinically suspected myocarditis, abnormal ECG parameters are associated with abnormal tissue characteristics detected by CMR. Further, ECG and CMR findings have independent prognostic implications for morbidity and mortality. Integrating both exams into clinical decision-making may play a role in risk stratification in this heterogeneous patient population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Anesthesiology / Arrhythmia / Biology and Life Sciences / Cardiology / Cardiomyopathy / Cardiovascular disease / Cardiovascular Diseases - etiology / Clinical decision making / Congestive heart failure / Contrast Media - chemistry / Coronary vessels / Decision making / Echocardiography / Edema / EKG / Electrocardiography / Electrocardiography - methods / Female / Gadolinium / Heart transplantation / Hospitals / Humans / Low voltage / Magnetic resonance / Magnetic Resonance Imaging - methods / Male / Medical diagnosis / Medical schools / Medicine / Medicine and Health Sciences / Middle Aged / Morbidity / Myocarditis / Myocarditis - complications / Myocarditis - diagnosis / Myocarditis - diagnostic imaging / Myocarditis - mortality / Pain / Parameters / Patients / Physical Sciences / Prognosis / Research and Analysis Methods / Retrospective Studies / Risk Assessment - methods / Transplantation / Ventricle / Voltage / Womens health