Background: There is a major unmet need to identify high-risk patients in myocarditis. Although decreasing cardiac and inflammatory markers are commonly interpreted as resolving myocarditis, this assumption has not been confirmed as of today. We sought to evaluate whether routine laboratory parameters at diagnosis predict dynamic of late gadolinium enhancement (LGE) as persistent LGE has been shown to be a risk marker in myocarditis.

Methods and Results: Myocarditis was diagnosed based on clinical presentation, high-sensitivity troponin T, and cardiac magnetic resonance imaging, after exclusion of obstructive coronary artery disease by angiography. Cardiac magnetic resonance imaging was repeated at 3 months. LGE extent was analyzed with the software GT Volume. Change in LGE >20% was considered significant. Investigated cardiac and inflammatory markers included high-sensitivity troponin T, creatine kinase, myoglobin, N-terminal B-type natriuretic peptide, C-reactive protein, and leukocyte count. Twenty-four patients were enrolled. Absolute levels of cardiac enzymes and inflammatory markers at baseline did not predict change in LGE at 3 months. Cardiac and inflammatory markers had normalized in 21 patients (88%). LGE significantly improved in 16 patients (67%); however, it persisted to a lesser degree in 17 of them (71%) and increased in a small percentage (21%) despite normalization of cardiac enzymes.

Conclusions: This is the first study reporting that cardiac enzymes and inflammatory parameters do not sufficiently reflect LGE in myocarditis. Although a majority of patients with normalizing laboratory markers experienced improved LGE, in a small percentage LGE worsened. These data suggest that cardiac magnetic resonance imaging might add value to currently existing diagnostic tools for risk assessment in myocarditis.

背景：识别心肌炎高危患者的主要需求尚未得到满足。尽管通常将减少心脏和炎症标志物解释为解决心肌炎，但直到今天仍未确认该假设。我们试图评估诊断时的常规实验室参数是否能预测as的晚期动态（LGE），因为已经证明持续性LGE是心肌炎的危险标志物。

方法和结果：在通过血管造影排除梗阻性冠状动脉疾病后，根据临床表现，高敏感性肌钙蛋白T和心脏磁共振成像诊断出心肌炎。在3个月时重复进行心脏磁共振成像。使用软件GT Volume对LGE范围进行了分析。LGE的变化> 20％被认为是重要的。研究的心脏和炎症标志物包括高敏感性肌钙蛋白T，肌酸激酶，肌红蛋白，N端B型利钠肽，C反应蛋白和白细胞计数。招募了二十四名患者。基线时心脏酶和炎性标志物的绝对水平不能预测3个月时LGE的变化。21例患者（88％）的心脏和炎症标志已恢复正常。LGE明显改善16例（67％）；然而，

结论：这是第一项报道心脏酶和炎性参数不能充分反映心肌炎中LGE的研究。尽管大多数具有正常实验室指标的患者的LGE有所改善，但有一小部分LGE恶化。这些数据表明，心脏磁共振成像可能会增加当前用于诊断心肌炎风险的诊断工具的价值。