Purpose
Left ventricular function recovery is more frequent in children with biopsy-proven lymphocytic myocarditis than in children with non-inflammatory cardiomyopathy.
Cardiac Magnetic Resonance (CMR) imaging is a convenient non-invasive tool to confirm inflammatory disease of the myocardium and it might be useful to predict outcome at diagnosis of pediatric dilated cardiomyopathy.
AIM OF THE STUDY
To analyze the predictive role of myocardial inflammation assessed by CMR on the outcome of recently diagnosed cardiac dysfunction in children.
Methods and Materials
Over a period of 4 years,
66 children underwent CMR at diagnosis of dilated cardiomyopathy with left ventriculardysfunction.
CMR sequences included unenhanced cine-steady state free precession (SSFP),
black-blood-prepared T1-weighted images,
T2-weighted images,
gadolinium enhanced T1-weighted images (EGE) and late gadolinium-enhanced (LGE).
Myocardial inflammation was defined if al least two of the following criteria were present:
1) signal hyperintensity in T2-weighted images
2) EGE in cine SSFP and/or in T1 post-contrast images
2) LGE
Results
Inflammatory cardiomyopathy was diagnosed in 33/66 children (MI group) and CMR showed no myocardial inflammation in 33/66 children (no-MI group).
T2 hypersignal was present in 31 cases,
EGE in 29 cases and LGE in 31 cases.
Fifty-seven patients survived without heart transplantation (3 deaths,
1 heart transplantation,
5 lost to follow-up).
After a mean follow-up of 24 months,
LV function recovery was more frequent in the MI group (24 vs.11,
p<0.05) with an OR for prediction of recovery of 5.2 in multilogistic regression.
Persisting LGE...
Conclusion
CONCLUSION
CMR is a valuable tool to diagnose myocardial inflammation in children with recently diagnosed LV dysfunction.
Presence of myocardial inflammation on CMR is a predictor of left ventricular recovery and better outcome.
