Cardiovascular magnetic resonance in Myocarditis: Insights into Diverse clinical presentations

Cau, Riccardo

First

;Fazzini, Luca;Angius, Simone;Marchetti, Maria Francesca;Suri, Jasjit S.;Guglielmo, Marco;Salgado, Rodrigo;Natale, Luigi;Montisci, Roberta;Saba, Luca

2026-01-01

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Abstract

Aims Myocarditis is an inflammatory condition with a wide spectrum of clinical presentations, ranging from low-to high-risk cases. This study aimed to evaluate the association between cardiovascular magnetic resonance (CMR) findings and different clinical presentation patterns. Material and method This retrospective study included 94 consecutive patients with acute myocarditis (74 males,78 %: mean age 37.62 ± 17.87 years) who met the diagnostic criteria for clinically suspected myocarditis with an acute presentation and underwent CMR examinations fulfilling the revised Lake Louise Criteria. The patients were stratified according to the classification proposed by Ammirati et al based on clinical parameters. Of these, 77 patients were assigned to the uncomplicated presentation category (63 males, mean age 39.10 ± 18.12 years), while 17 were classified into complicated presentation category (11 males, 65 %; mean age 30.33 ± 15.24 years) Results Patients with complicated clinical presentation demonstrated higher troponin levels (p = 0.002), lower left ventricular ejection fraction (p = 0.021), reservoir strain (p = 0.02), conduit strain (p = 0.01), global longitudinal strain (p = 0.002), and global circumferential strain (p = 0.003) compared to low-risk patients. Additionally, the complicated group exhibited a greater extent of late gadolinium enhancement (LGE) and more frequent septal involvement of LGE (p = 0.001 for both) compared to the uncomplicated group. In multivariable analysis, septal LGE emerged as the only independent discriminator between the different clinical presentation patterns (p = 0.033) Conclusion The pattern of CMR findings appears to vary among acute myocarditis patients based on their clinical presentation patterns. Septal LGE was independently associated with a higher risk profile in acute myocarditis patients.