BACKGROUND Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. METHODS Six hundred seventy consecutive patients (48 ± 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods. RESULTS Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02-1.08, p = 0.001; HR 1.02, 95%CI:1.00-1.04; p = 0.001; HR 1.02, 95%CI: 1.00-1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04-1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values. CONCLUSIONS FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients. TRIAL REGISTRATION NUMBER NCT03470571 . Registered 13th March 2018. Retrospectively registered.

中文翻译：

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心血管磁共振成像心肌纤维化量化方法对疑似心肌炎患者危险分层的比较。


背景虽然使用心血管磁共振成像（CMR）的晚期钆增强（LGE）的存在是疑似心肌炎患者事件的重要鉴别因素，但没有关于最佳LGE量化方法的数据。方法 2002 年至 2015 年间，连续纳入了 670 名疑似心肌炎患者（48 ± 16 岁，59% 男性）。我们使用基于 2、3、4、5、6、远程心肌上方 7 个标准差 (SD) 或半峰全宽 (FWHM)。此外，还评估了 LGE 视觉存在评分 (LGE-VPS)（每个节段中存在/不存在 LGE）。对于每种方法，都确定了 LGE 结果与主要不良心脏事件 (MACE) 的关联强度。对所有方法均使用组内相关系数 (ICC) 进行评估者间和评估者内变异性。结果 98 名 (15%) 患者在 4.7 年的中期随访中出现 MACE。通过 FWHM、2- 和 3-SD 进行的 LGE 量化证明与 MACE 存在单变量关联（风险比 [HR] 1.05，95% 置信区间 [CI]：1.02-1.08，p = 0.001；HR 1.02，95% CI：1.00-1.04 ；p = 0.001；HR 1.02，95%CI：1.00-1.05，p = 0.035，分别），而 4-SD 至 7-SD 方法未达到显着关联。 LGE-VPS 还证明与 MACE 相关（HR 1.09，95%CI：1.04-1.15，p < 0.001）。在多变量模型中，FWHM、2-SD 方法和 LGE-VPS 均显示与根据年龄、性别、BMI 和 LVEF 调整后的 MACE 显着相关（调整后 HR 为 1.04、1.02 和 1.07；p = 0.009、p = 0.035；和 p = 0.005，分别）。 其中，FWHM 和 LGE-VPS 由于其高 ICC 值而具有最高程度的评估者间和评估者内再现性。结论 FWHM 是疑似心肌炎患者风险分层的最佳半自动定量方法，证明与 MACE 的关联性最强，技术一致性也最高。视觉 LGE 评分是一种可靠的替代方法，并且与这些患者的 MACE 和可重复性具有可比的关联性。试用注册号 NCT03470571。 2018年3月13日注册。追溯注册。