TY - JOUR
T1 - Different Phases of Disease in Lymphocytic Myocarditis: Clinical and Electrophysiological Characteristics
AU - Casella, M.
AU - Gasperetti, A.
AU - Compagnucci, P.
AU - Narducci, Maria Lucia
AU - Pelargonio, Gemma
AU - Catto, V.
AU - Carbucicchio, C.
AU - Bencardino, Gianluigi
AU - Conte, Eliana
AU - Schicchi, N.
AU - Andreini, D.
AU - Pontone, G.
AU - Giovagnoni, A.
AU - Rizzo, S.
AU - Inzani, Frediano
AU - Basso, C.
AU - Natale, A.
AU - Tondo, C.
AU - Russo, A. D.
AU - Crea, Filippo
PY - 2023
Y1 - 2023
N2 - Background: Endomyocardial biopsy (EMB) is required to make a definite diagnosis of lymphocytic myocarditis (LM), to identify its etiology, and to classify LM into different phases. Objectives: This study aims to characterize and compare clinical and electrophysiological characteristics of different biopsy-proven LM phases, namely acute myocarditis (AM), chronic active myocarditis (CAM), and healed myocarditis (HM). Methods: All patients with a diagnosis of LM at 3 Italian referral centers were prospectively enrolled. According to EMB findings, LM was classified as AM, CAM, or HM; per-group comparisons of clinical presentations, noninvasive, and invasive findings are reported. Results: Among the 122 enrolled patients (AM, n = 44; CAM, n = 42; HM, n = 36), complex ventricular arrhythmias were very common overall (n = 109, 89%), but ventricular fibrillation was slightly more prevalent in AM (P = 0.028). Cardiac magnetic resonance imaging showed late gadolinium enhancement in more patients with HM and CAM than AM (94.4% vs 92.9% vs 50%; P < 0.001), whereas edema was more common in AM than in CAM, being absent in HM (90.9% vs 50% vs 0%; P < 0.001). Accordingly, edema was the strongest independent clinical predictor of EMB-proven active inflammation. Electroanatomical mapping revealed a lower prevalence of low-voltage areas in AM than in CAM or HM. We observed a strong association between edema at a specific myocardial segment and normal voltages at that site (odds ratio: 0.24; 95% CI: 0.10-0.54; P < 0.01), as well as between late gadolinium enhancement and low-voltage areas (odds ratio: 2.86; 95% CI: 1.19-6.97; P = 0.019). Conclusions: LM is a highly heterogeneous disease, and its different phases are characterized by diverse clinical, morphological, and electrophysiological features. Further research is required to identify electroanatomical markers of inflammation.
AB - Background: Endomyocardial biopsy (EMB) is required to make a definite diagnosis of lymphocytic myocarditis (LM), to identify its etiology, and to classify LM into different phases. Objectives: This study aims to characterize and compare clinical and electrophysiological characteristics of different biopsy-proven LM phases, namely acute myocarditis (AM), chronic active myocarditis (CAM), and healed myocarditis (HM). Methods: All patients with a diagnosis of LM at 3 Italian referral centers were prospectively enrolled. According to EMB findings, LM was classified as AM, CAM, or HM; per-group comparisons of clinical presentations, noninvasive, and invasive findings are reported. Results: Among the 122 enrolled patients (AM, n = 44; CAM, n = 42; HM, n = 36), complex ventricular arrhythmias were very common overall (n = 109, 89%), but ventricular fibrillation was slightly more prevalent in AM (P = 0.028). Cardiac magnetic resonance imaging showed late gadolinium enhancement in more patients with HM and CAM than AM (94.4% vs 92.9% vs 50%; P < 0.001), whereas edema was more common in AM than in CAM, being absent in HM (90.9% vs 50% vs 0%; P < 0.001). Accordingly, edema was the strongest independent clinical predictor of EMB-proven active inflammation. Electroanatomical mapping revealed a lower prevalence of low-voltage areas in AM than in CAM or HM. We observed a strong association between edema at a specific myocardial segment and normal voltages at that site (odds ratio: 0.24; 95% CI: 0.10-0.54; P < 0.01), as well as between late gadolinium enhancement and low-voltage areas (odds ratio: 2.86; 95% CI: 1.19-6.97; P = 0.019). Conclusions: LM is a highly heterogeneous disease, and its different phases are characterized by diverse clinical, morphological, and electrophysiological features. Further research is required to identify electroanatomical markers of inflammation.
KW - cardiac magnetic resonance imaging
KW - electroanatomical mapping
KW - ventricular arrhythmias
KW - myocarditis
KW - substrate characterization
KW - endomyocardial biopsy
KW - cardiac magnetic resonance imaging
KW - electroanatomical mapping
KW - ventricular arrhythmias
KW - myocarditis
KW - substrate characterization
KW - endomyocardial biopsy
UR - http://hdl.handle.net/10807/305465
U2 - 10.1016/j.jacep.2022.10.004
DO - 10.1016/j.jacep.2022.10.004
M3 - Article
SN - 2405-5018
VL - 9
SP - 314
EP - 326
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
ER -