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Relationship between electrocardiographic changes and cardiac magnetic resonance imaging in acute myocarditis J. Silva Marques, AG. Almeida, M. Menezes, R. Magalhaes, C. Jorge, M. Gato Varela, L. Santos, D. Brito, A. Nunes Diogo, MG. Lopes CHLN, EPE- Hospital de Santa Maria , Cardiology I Lisbon Medical Faculty Lisbon, Portugal Lisbon, Portugal Acute myocarditis is a disease of heterogeneous clinical presentation, ranging from analytical or electrocardiographic abnormalities in asymptomatic patients to acute heart failure and even sudden cardiac death. Endomyocardial biopsy was the first diagnostic tool to be used, but presents low sensitivity, is invasive and is not devoid of significant risks. Cardiac magnetic resonance (CMR) imaging has shown high diagnostic accuracy and is accepted as an alternative to myocardial biopsy for diagnostic purposes. The ECG presentation of myocarditis is heterogeneous, being described more frequently ST-T changes. The sensitivity of the ECG has been little explored, but the data gathered so far reported low sensitivity (49% to 73%). Additionally, there are no studies to correlate topographically electrocardiographic findings with CMR data in acute myocarditis. Therefore, we aim to determine the sensitivity of the ECG for detecting myocarditis and its capability to predict the extension of myocardial lesions using CMR as the gold standard. ECG changes n Sensitivity ST-segment elevation 17 77% T-wave inversion 11 50% ST-elevation or T-wave inversion 19 86% Wall Anterior Lateral Inferior ST-elevation 47% 100% 50% T-wave inversion 93% 100% 78% Oedema expressed as T2 hyperintensity (left) and necrosis ECG showing anterior ST-elevation in detected by late gadolinium Acute Myocarditis enhancement (right) We included 22 consecutive patients (17 ♂, 5 ♀, 29.8±13.6 years) with the diagnosis of acute myocarditis, established according to defined criteria. Definition of Acute Myocarditis (at least 2 of the following): 1) chest pain and/or heart failure, 2) increased levels of markers of myocardial necrosis, 3) normal coronary angiography; 4) diagnosis confirmed by CMR. A 12-lead ECG was done at admission. The following ECG changes were recorded: ST segment elevation or inverted T waves and location of ECG changes (anterior, lateral, inferior or generalized). CMR T2 weighted sequences for oedema assessment and late gadolinium enhancement for analysis of necrosis were obtained. The left ventricle was divided into 16 segments (ASE) for analysis of the presence of oedema and necrosis. For comparative analysis with the ECG, 4 locations were considered at CMR: anterior (anterior septum and anterior wall), lateral (lateral and posterior walls), inferior (inferior wall and inferior septum) and generalized. The criteria used to define topographic concordance of ECG with CMR were: the correlation of ≥ 1 location in each patient if ≤ 2 locations affected and if there were widespread ECG changes there would have to be ≥ 2 locations exhibiting changes at CMR. Wall Anterior Lateral Inferior Wall Anterior Lateral Inferior ST-elevation 71% 52% 50% ST-elevation 54% 53% T-wave inversion 14% 48% 50% T-wave inversion 92% 74% Wall Anterior Lateral Inferior Detected abnorality Oedema Necrosis ST-elevation 78% 50% 67% ST-elevation n 8 11 % 47% 65% T-wave inversion 11% 45% 33% T-wave inversion n 10 10 % 91% 91% ST-elevation or T-wave inversion n % 15 79% 16 84% -ECG changes usually attributed to myocardial infarction have proved to have good sensitivity for the detection of myocarditis. -Either ST-elevation or T wave invertion were good predictors of the location of edema and necrosis at CMR.
