Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis
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ORIGINAL PAPER
Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis Giulia Cundari1 · Nicola Galea1 · Gianluca De Rubeis1 · Andrea Frustaci1 · Francesco Cilia1 · Giuseppe Mancuso1 · Livia Marchitelli1 · Federica Catapano1 · Iacopo Carbone1 · Carlo Catalano1 · Marco Francone1 Received: 5 July 2020 / Accepted: 2 November 2020 © The Author(s) 2020
Abstract The purpose of our study was to compare diagnostic performance of old and new Lake Louise Criteria (oLLC and nLLC) among different clinical presentations: infarct-like (IL), cardiomyopathic (CM) and arrhythmic (AR). 102 patients with clinical suspicion of acute myocarditis underwent cardiac magnetic resonance (CMR) on a 1.5 T scanner. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping, early and late gadolinium enhancement and T1 mapping acquired before and after gadolinium administration. The degree of agreement has been calculated with Cohen’s K test. 42 patients also underwent endomyocardial biopsy (EMB). IL onset was present in 54/102 patients, CM in 28/102 and AR in 20/102. nLLC were positive in 58.3% of the patients, while oLLC in 37.9%, k = 0.57 (IC: 0.428–0.713). The degree of agreement between nLLC and oLLC was 0.49 (IC: 0.111–0.876) for AR onset (nLLC positive in 35% vs oLLC in 15%), 0.25 (IC: 0.035–0.459) for CM pattern (nLLC positive in 60.7% vs oLLC 17.9%) and 0.73 (IC: 0.543–0.912) for IL presentation (nLLC positive in 66.7% vs oLLC in 57.4%). Diagnostic accuracy was 75% for both nLLC and oLLC among IL onset, and 41.6% for oLLC vs 66.7% for nLLC, as regards CM clinical presentation. nLLC have improved diagnostic performance of CMR for the diagnosis of acute myocarditis, in particular for atypical clinical presentation. Keywords Myocarditis · Agreement · Diagnostic accuracy · Lake Louise criteria · Atypical onsets Abbrevations AM Acute Myocarditis AR Arrhythmic BSA Body Surface Area CI Confidence Interval CM Cardiomyopathic CMR Cardiac Magnetic Resonance DA Diagnostic Accuracy ECG Electrocardiogram ECV Extracellular Volume EDV End Diastolic Volume EF Ejection Fraction EGE Early Gadolinium Enhancement EMB Endomyocardial Biopsy FM Fulminant Myocarditis IL Infarct-Like * Giulia Cundari [email protected] 1
Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
GRE Gradient Echo LLC Lake Louise Criteria LGE Late Gadolinium Enhancement LV Left ventricle MOLLI Modified Look Locker Inversion Recovery oLLC Old Lake Louise Criteria nLLC New Lake Louise Criteria PCR Polymerase Chain Reaction PSIR Phase Sensitive Inversion Recovery ROI Region of Interest TSE Turbo Spin Echo
Introduction Clinical presentations of acute myocarditis (AM) vary through a wide range of manifestations [1, 2], affecting either children [3] or adults [4]. The infarct-like onset, the most common clinical pattern [5] which seems to be mostly correlated to Parvovirus B19 infection [6], is characterized by flu-like symptoms followed by che
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