CV_Prognostic value of visual and quantitative CMR regional myocardialBenedikt Bernhard¹ · Philippe Joss² · Noah Greisser₂ · Anselm W. Stark² · Jonathan Schütze² · Isaac Shiri² · Yasaman Safarkhanlo² · Kady Fischer³ · Dominik P. Guensch³ · Jessica A. M. Bastiaansen^4,5 · Maryam Pavlicek² · Dominik C. Benz¹ · Raymond Y. Kwong¹ · Christoph Gräni^2,6

Received: 22 November 2023 / Accepted: 17 January 2024
© The Author(s) 2024

Abstract According to updated Lake-Louise Criteria, impaired regional myocardial function serves as a supportive criterion in diagnosing myocarditis. This study aimed to assess visual regional wall motional abnormalities (RWMA) and novel quantitative regional longitudinal peak strain (RLS) for risk stratification in the clinical setting of myocarditis. In patients undergoing CMR and meeting clinical criteria for suspected myocarditis global longitudinal strain (GLS), late gadolinium enhancement (LGE), RWMA and RLS were assessed in the anterior, septal, inferior, and lateral regions and correlated to the occurrence of major adverse cardiac events (MACE), including heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis, and all-cause death. In 690 consecutive patients (age: 48.0 ± 16.0 years; 37.7% female) with suspected myocarditis impaired RLS was correlated with RWMA and LV-GLS but not with the presence of LGE. At median follow up of 3.8 years, MACE occurred in 116 (16.8%) patients. Both, RWMA and RLS in anterior-, septal-, inferior-, and laterallocations were univariately associated with outcomes (all p < 0.001), but not after adjusting for clinical characteristics and LV-GLS. In the subgroup of patients with normal LV function, RWMA were not predictive of outcomes, whereas septal
RLS had incremental and independent prognostic value over clinical characteristics ( HRadjusted = 1.132, 95% CI 1.020–1.256; p = 0.020). RWMA and RLS can be used to assess regional impairment of myocardial function in myocarditis but are of limited prognostic value in the overall population. However, in the subgroup of patients with normal LV function, septal
RLS represents a distinctive marker of regional LV dysfunction, offering potential for risk-stratification.

GKB-NON-2024-00192