The Evolving Phenotype of Myocarditis: The Role of Cardiovascular Magnetic Resonance from Acute Injury to Healing and Residual Scar
- 1Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126 Verona, Italy
- 2Department of Clinical and Molecular Medicine, Sapienza University, Via Giorgio Nicola Papanicolau, 00189 Rome, Italy
Abstract
Myocarditis is a dynamic disease, and myocardial oedema, injury, ventricular dysfunction, and fibrosis may evolve differently over time. Cardiovascular magnetic resonance (CMR) has become central to its non-invasive assessment, providing complementary information on myocardial tissue through T2-sensitive imaging, native T1, extracellular volume (ECV), and late gadolinium enhancement (LGE). The meaning of these findings, however, depends on when imaging is performed. Follow-up CMR may therefore provide a better understanding of myocardial recovery, helping to characterize resolving myocardial injury, persistent tissue abnormalities, and residual post-acute changes. Based on the temporal evolution of CMR findings, we propose four conceptual patterns of myocardial recovery: near-complete imaging recovery; resolving oedema/injury-pattern abnormalities; persistent oedema/injury-pattern abnormalities; post-acute injury with residual LGE and potential structural remodelling. These patterns are intended as a framework for interpreting serial CMR rather than as formally validated imaging phenotypes, and should be considered complementary to contemporary clinical disease-stage and mechanistic classifications. In selected patients, integration with echocardiography, molecular imaging, genetics, and endomyocardial biopsy may provide further insight into the underlying disease process. Whether this longitudinal approach can improve risk stratification and ultimately guide therapeutic decisions remains an important question for future studies.
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BibTeX
@article{rossignoli2026evolving,
title = {{The Evolving Phenotype of Myocarditis: The Role of Cardiovascular Magnetic Resonance from Acute Injury to Healing and Residual Scar}},
author = {Carlotta Rossignoli and Roberto Scarsini and Giorgia Alberti and Giovanni Benfari and Leonardo Portolan and Martina Magistri and Alessia Gambaro and Flavio Ribichini and Anna Piccoli},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218352},
url = {https://www.mdpi.com/2077-0383/15/21/8352},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Evolving Phenotype of Myocarditis: The Role of Cardiovascular Magnetic Resonance from Acute Injury to Healing and Residual Scar
AU - Carlotta Rossignoli
AU - Roberto Scarsini
AU - Giorgia Alberti
AU - Giovanni Benfari
AU - Leonardo Portolan
AU - Martina Magistri
AU - Alessia Gambaro
AU - Flavio Ribichini
AU - Anna Piccoli
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218352
UR - https://www.mdpi.com/2077-0383/15/21/8352
AB - Myocarditis is a dynamic disease, and myocardial oedema, injury, ventricular dysfunction, and fibrosis may evolve differently over time. Cardiovascular magnetic resonance (CMR) has become central to its non-invasive assessment, providing complementary information on myocardial tissue through T2-sensitive imaging, native T1, extracellular volume (ECV), and late gadolinium enhancement (LGE). The meaning of these findings, however, depends on when imaging is performed. Follow-up CMR may therefore provide a better understanding of myocardial recovery, helping to characterize resolving myocardial injury, persistent tissue abnormalities, and residual post-acute changes. Based on the temporal evolution of CMR findings, we propose four conceptual patterns of myocardial recovery: near-complete imaging recovery; resolving oedema/injury-pattern abnormalities; persistent oedema/injury-pattern abnormalities; post-acute injury with residual LGE and potential structural remodelling. These patterns are intended as a framework for interpreting serial CMR rather than as formally validated imaging phenotypes, and should be considered complementary to contemporary clinical disease-stage and mechanistic classifications. In selected patients, integration with echocardiography, molecular imaging, genetics, and endomyocardial biopsy may provide further insight into the underlying disease process. Whether this longitudinal approach can improve risk stratification and ultimately guide therapeutic decisions remains an important question for future studies.
SN - 2077-0383
ER -