Persistence of Late Gadolinium Enhancement on Follow-Up CMR Imaging in Children with Acute Myocarditis
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ORIGINAL ARTICLE
Persistence of Late Gadolinium Enhancement on Follow‑Up CMR Imaging in Children with Acute Myocarditis Siddharth Dubey1 · Arpit Agarwal2 · Stephanie Nguyen3 · Dilachew Adebo4 Received: 19 January 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cardiac magnetic resonance (CMR) imaging is the gold standard non-invasive test for the diagnosis of acute myocarditis. Late gadolinium enhancement (LGE) on CMR imaging signifies myocardial fibrosis or scar but information on long-term followup in pediatric patients is limited. The aim of this study is to evaluate the persistence of LGE in follow-up CMR imaging and highlight the need for serially following LGE after acute myocarditis in children. A retrospective review of the CMR images in pediatric patients less than 18 years of age at Children’s Memorial Hermann Hospital was performed from October 31, 2010, to December 31, 2017. The ages of the patients included in the study ranged from 10 to 17 years. Out of 34 subjects, 12 subjects had a follow-up CMR imaging after the initial CMR imaging. Cardiac enzymes and inflammatory markers were elevated in all patients on initial presentation with normalization seen for all patients on follow-up testing. Baseline CMR imaging demonstrated depressed function in 50% of patients (6/12) with recovery of biventricular function seen in all except for one patient. LGE was detected in 10 out of 12 patients on baseline CMR and persisted in all on follow--up CMR imaging. Two patients did not have LGE at baseline CMR and had no evidence of LGE at follow-up CMR. Despite resolution of acute myocardial inflammation, LGE persisted in all of our study subjects. There is neither an agreement on time interval to perform follow-up CMR, nor on duration of follow-up. We recommend large-scale prospective CMR study for long-term follow-up evaluation of children after acute myocarditis. Keywords Late gadolinium enhancement · Acute myocarditis · CMR imaging · Pediatric Abbreviations LGE Late gadolinium enhancement CMR imaging Cardiac magnetic resonance imaging
* Siddharth Dubey [email protected] Arpit Agarwal [email protected] Stephanie Nguyen [email protected] Dilachew Adebo [email protected] 1
Pediatric Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
2
Pediatric Cardiology, Baylor College of Medicine, The Children’s Hospital of San Antonio, San Antonio, TX, USA
3
Cardiothoracic Surgery, New York Presbyterian–Columbia University Medical Center, New York, NY, USA
4
Pediatric Cardiology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
Background Cardiac magnetic resonance (CMR) imaging is currently regarded as the gold standard non-invasive test for the diagnosis of acute myocarditis. CMR imaging offers greater accuracy in detecting myocardial dysfunction and myocardial inflammation. There is a proposed diagnostic CMR criteria derived from the common consensus amon
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