The Prognostic Value of Cardiovascular Magnetic Resonance Derived Pulmonary Capillary Wedge Pressure in Acute Myocarditis (RF_TH_195)

Thursday, January 30, 2025

1:50 PM – 2:00 PM East Coast USA Time

Location: Blue Room PreFunction - Kiosk 1

Presenting Author(s)

SR

Sachit Rustagi, BSc

Medical Student
The Ohio State University College of Medicine

Primary Author(s)

SR

Sachit Rustagi, BSc

Medical Student
The Ohio State University College of Medicine

Co-Author(s)

Deborah Kwon, MD, FSCMR

Director of Cardiac MRI
Cleveland Clinic
KG

Katarzyna E. Gil, MD, PhD

Assistant Professor
The Ohio State University
VT

Vien Truong, MD

Internal Medicine Resident
Nazareth Hospital
SS

Suzanne Smart, BSc, CCRP

Research Associate
The Ohio State University
TK

Theerawat Korkerdsup, MD

Advance imaging cardiologist
Bangpakok 9 International Hospital , Thailand
CP

Cassady Palmer, BSc

Research Associate
The Christ Hospital Health Network
WM

Wojciech M Mazur, MD

Director of Advanced Cardiac Imaging
The Christ Hospital Health Network
Subha Raman, MD

Vice President
OhioHealth
Karolina M. Zareba, MD

Associate Professor
The Ohio State University

Background: Cardiovascular magnetic resonance (CMR) is an integral part of diagnosis and prognostication in acute myocarditis. The acute presentation of myocarditis can be complicated by the presence of acute heart failure (HF). The measurement of pulmonary capillary wedge pressures (PCWP) adds significant value to diagnosis and prognosis. Recently, a CMR derived PCWP has been proposed (1). We sought to evaluate CMR derived PCWP in patients admitted with acute myocarditis and evaluate its prognostic value.

Methods: Patients with a discharge diagnosis of myocarditis who underwent comprehensive inpatient CMR exams at 1.5 Tesla were retrospectively identified. Patients meeting the updated Lake Louise Criteria for acute myocarditis were included. CMR analysis included volumetric atrial and ventricular analysis, T1 and T2 mapping, extracellular volume fraction (ECV), late gadolinium enhancement (LGE), and left ventricular mass assessment. CMR derived PCWP was calculated utilizing the following published formula: CMR PCWP = 6.1352 + (0.07204 * left atrial volume) + (0.02256 * left ventricular mass). Elevated PCWP was defined as ≥ 15 mmHg. The primary outcome was all-cause mortality and statistical significance was established at p < 0.05.

Results: A total of 105 patients (mean age 39.9 ± 16.8 years, 42 percent female) with acute myocarditis were included in the analysis. Elevated CMR derived PCWP ≥ 15 mmHg was noted in 14 patients (13.3%). During a median follow-up of 6.8 ± 1.7 years, 17 patients reached the primary endpoint of all-cause mortality: 5/14 (35.7%) in the elevated PCWP group and 12/91 (13.2%) in the non-elevated PCWP cohort. Elevated PCWP was significantly associated with all-cause mortality (HR: 2.9, 95% CI: 1.04–8.37, p = 0.04), Figure 1. Correlative analyses between various CMR parameters and PCWP showed significant correlation with LVEF (r = -0.62, p < 0.001), and to a lesser extent mean T2 signal (r = 0.2, p = 0.049). ECV and LGE extent were not correlated with PCWP. After adjusting for age, increased PCWP remained associated with all-cause mortality (HR: 3.42, 95% CI: 1.18–9.95, p = 0.02).

Conclusion: In patients admitted with acute myocarditis, confirmed by the updated Lake Louise criteria, elevated CMR derived PCWP was significantly associated with all-cause mortality. Initial data on the utilization of PCWP for risk stratification of patients with acute myocarditis are promising.