Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging.
<h4>Background</h4>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 clinic...
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0227134&type=printable |
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| author | Kady Fischer Maximilian Marggraf Anselm W Stark Kyoichi Kaneko Ayaz Aghayev Dominik P Guensch Adrian T Huber Michael Steigner Ron Blankstein Tobias Reichlin Stephan Windecker Raymond Y Kwong Christoph Gräni |
| author_facet | Kady Fischer Maximilian Marggraf Anselm W Stark Kyoichi Kaneko Ayaz Aghayev Dominik P Guensch Adrian T Huber Michael Steigner Ron Blankstein Tobias Reichlin Stephan Windecker Raymond Y Kwong Christoph Gräni |
| author_sort | Kady Fischer |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods and results</h4>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).<h4>Conclusion</h4>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. |
| format | Article |
| id | doaj-art-ee269f7eec3c4f3d9e027cf195fba282 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-ee269f7eec3c4f3d9e027cf195fba2822025-08-20T02:11:20ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e022713410.1371/journal.pone.0227134Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging.Kady FischerMaximilian MarggrafAnselm W StarkKyoichi KanekoAyaz AghayevDominik P GuenschAdrian T HuberMichael SteignerRon BlanksteinTobias ReichlinStephan WindeckerRaymond Y KwongChristoph Gräni<h4>Background</h4>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.<h4>Methods and results</h4>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).<h4>Conclusion</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0227134&type=printable |
| spellingShingle | Kady Fischer Maximilian Marggraf Anselm W Stark Kyoichi Kaneko Ayaz Aghayev Dominik P Guensch Adrian T Huber Michael Steigner Ron Blankstein Tobias Reichlin Stephan Windecker Raymond Y Kwong Christoph Gräni Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. PLoS ONE |
| title | Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. |
| title_full | Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. |
| title_fullStr | Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. |
| title_full_unstemmed | Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. |
| title_short | Association of ECG parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for CMR imaging. |
| title_sort | association of ecg parameters with late gadolinium enhancement and outcome in patients with clinical suspicion of acute or subacute myocarditis referred for cmr imaging |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0227134&type=printable |
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