Application Of Cardiac Magnetic Resonance In Children With Acute Fulminant Myocarditis

Part ?The Diagnostic and Follow-up Value of Cardiac Magnetic Resonance in Children with Acute Fulminant MyocarditisObjectiveTo investigate the clinical features and the diagnostic and follow-up value of cardiac magnetic resonance in children with acute fulminant myocarditis(AFM).MethodsA total of 20 children diagnosed with AFM admitted to our department were reviewed,and the clinical manifestations;pathogenic examination results;myocardial injury biomarkers;and electrocardiography,echocardiogram and cardiac magnetic resonance(CMR)results were analyzed.ResultsTwenty children with AFM,including 12 males and 8 females,aged 3-16 years,were analyzed.The initial symptoms were abdominal pain,vomiting,fatigue,syncope,and convulsions.All children had significantly increased hypersensitive cardiac troponin T(hs-cTnT)and N-terminal pro-B-type natriuretic peptide(NT-proBNP).In addition to nonspecific ST-T changes,there were 10 cases of complete atrioventricular block,2 cases of advanced atrioventricular block,and 1 case of ventricular tachycardia.Echocardiography showed an increase in the cardiac chamber sizes in 15 patients and a decrease in left ventricular ejection fraction(LVEF)in 17 patients.There were 16 patients with abnormal CMR findings,including 13 cases of high T2-weighted image(T2WI)signal and 14 cases of late gadolinium enhancement(LGE).In the patients who underwent CMR within 14 days of onset,the sensitivity of T2WI and LGE and the positive diagnosis rate were higher than in those who underwent CMR after 14 days,but the difference was not statistically significant.CMR was followed up in 10 patients:7 patients returned to normal,3 cases had persistent LGE,One of them developed inflammatory dilated cardiomyopathy after 4 months,and the other two were still being followed up.All patients were treated with high-dose immunoglobulin,11 of whom received high-dose immunoglobulin combined with glucocorticoids.Eight patients received temporary pacemakers,and 1 patient received extra-corporeal membrane oxygenation(ECMO).None of the patients died.The peak of hs-cTnT was significantly higher in the glucocorticoid group than in the unused glucocorticoid group(2853.4±2217.2 pg/ml and 1124.7±527.3 pg/ml,respectively).However,there was no significant difference between the length of hospital stay and the time for LVEF to return to normal.ConclusionCMR is highly sensitive in the diagnosis of AFM,especially within 14 days of onset,and is a useful noninvasive imaging technique for the early identification of AFM in children.The persistence of LGE may be an adverse factor in the development of AFM into inflammatory dilated cardiomyopathy.The dynamic observation and follow-up of children with AFM through CMR can guide clinical decision-making and prognosis assessment.Part ?The Differential Diagnosis Value of Cardiac Magnetic Resonance in Children with Acute Fulminant Myocarditis and Dilated CardiomyopathyObjectiveTo explore the differential diagnosis value of cardiac magnetic resonance(CMR)in children with acute fulminant myocarditis(AFM)and dilated cardiomyopathy(DCM).Methods20 AFM and 10 DCM children who were admitted to the Pediatric Cardiology Department of our hospital and underwent CMR examination between 2011-11 and 2020-01 were selected and divided into two groups:AFM group and DCM group.The initial symptoms,cardiac biomarkers,electrocardiograms,chest radiographs,echocardiograms,and CMR data were collected for comparative analysis.ResultsThe initial symptoms of AFM and DCM are more common with abdominal pain and vomiting.NYHA cardiac function of AFM group was mainly level III and IV,while DCM group was mainly level I and II.The hypersensitive cardiac troponin T(hs-cTnT)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the AFM group were significantly higher than those in the DCM group.The critical value of hs-cTnT in the diagnosis of AFM was 663.95 pg/ml.The electrocardiogram of AFM mainly showed atrioventricular block and extensive ST-T changes,and the DCM group was mainly premature ventricular contractions.The chest radiographs of the AFM and DCM groups both showed a 70%incidence of cardiac enlargement,and the difference was not statistically significant.There was also no significant difference in left ventricular ejection fraction.Results of CMR examination in the AFM group:13 cases of high T2-weighted image(T2WI)signal,14 cases of late gadolinium enhancement(LGE)(12 of them were patchy and 2 were linear),5 cases of myocardial thinning,and 6 cases of myocardial motility reduction,3 cases of myocardial perfusion defect,and 6 cases of pericardial effusion.Results of CMR examination in the DCM group:7 cases of LGE(2 of them were patchy and 5 were linear),6 cases of myocardial thinning,7 cases of myocardial motility reduction,6 cases of increased trabeculae,and 1 case myocardial perfusion defect,4 cases of pericardial effusion.There were statistically significant differences in high T2WI signal,increased trabeculae,and LGE morphology Conclusionhs-cTnT increased significantly,ECG showed atrioventricular block,CMR showed high T2WI signal,and patchy LGE patterns suggest AFM,and cardiac function level I or ?,ECG showed premature ventricular contractions,and CMR showed increased trabeculae and linear LGE patterns suggest DCM.CMR can provide effective differential diagnostic information for children with AFM and DCM.