Myocardial injury patterns on cardiac magnetic resonance: diffuse myocardial damage with prominent septal involvement in adults with severe myocarditis requiring extracorporeal membrane oxygenation
- 1Department of Emergency Medicine, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, 210029 China
- 2Radiology Department, The First Affiliated Hospital with Nanjing Medical University and Jiangsu Province Hospital, Nanjing, 210029 China
Abstract
Purpose: Patients with myocarditis suffering from cardiogenic shock may benefit from extracorporeal membrane oxygenation (ECMO). However, the characteristics of myocardial injury in these patients are unclear. Using cardiac magnetic resonance (CMR), we aimed to investigate cardiac changes in survivors with severe myocarditis treated with ECMO.
Methods: This retrospective study was conducted at the First Affiliated Hospital with Nanjing Medical University in Nanjing, China, from July 2018 to July 2022. Patients with severe myocarditis who underwent CMR within 30 days after discontinuing ECMO were included in this study.
Results: In total, 22 patients (median age: 33 years) were included. Late gadolinium enhancement (LGE) was detected within the interventricular septum (IVS) in all patients. The mean T1, T2, and extracellular volume (ECV) values showed similar distribution patterns to LGE. In an exploratory post-hoc age stratification based on the cohort median age of 33 years, we observed that several quantitative CMR parameters (mean ECV, minimum ECV, maximum ECV, mean T1, maximum T1, and minimum T2) were numerically higher in the older subgroup (p < 0.05). Myocardial injury was widespread in patients with severe myocarditis receiving ECMO.
Conclusions: Survivors of severe myocarditis who required ECMO support presented diffuse myocardial injury as the dominant pattern on early post-weaning CMR examination, with the interventricular septum showing notably prominent lesions among all myocardial segments.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12880-026-02614-7.
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BibTeX
@article{zhang2026myocardial,
title = {{Myocardial injury patterns on cardiac magnetic resonance: diffuse myocardial damage with prominent septal involvement in adults with severe myocarditis requiring extracorporeal membrane oxygenation}},
author = {Zhongman Zhang and Xiaole Zhu and Yi Zhu and Tianshi Li and Wei Li and Xiaomei Zhu and Xufeng Chen and Sae Rom Lee},
journal = {BMC Medical Imaging},
year = {2026},
month = jul,
doi = {10.1186/s12880-026-02614-7},
url = {https://doi.org/10.1186/s12880-026-02614-7},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Myocardial injury patterns on cardiac magnetic resonance: diffuse myocardial damage with prominent septal involvement in adults with severe myocarditis requiring extracorporeal membrane oxygenation
AU - Zhongman Zhang
AU - Xiaole Zhu
AU - Yi Zhu
AU - Tianshi Li
AU - Wei Li
AU - Xiaomei Zhu
AU - Xufeng Chen
AU - Sae Rom Lee
PY - 2026
DA - 2026/07/30
JO - BMC Medical Imaging
DO - 10.1186/s12880-026-02614-7
UR - https://doi.org/10.1186/s12880-026-02614-7
AB - Purpose: Patients with myocarditis suffering from cardiogenic shock may benefit from extracorporeal membrane oxygenation (ECMO). However, the characteristics of myocardial injury in these patients are unclear. Using cardiac magnetic resonance (CMR), we aimed to investigate cardiac changes in survivors with severe myocarditis treated with ECMO. Methods: This retrospective study was conducted at the First Affiliated Hospital with Nanjing Medical University in Nanjing, China, from July 2018 to July 2022. Patients with severe myocarditis who underwent CMR within 30 days after discontinuing ECMO were included in this study. Results: In total, 22 patients (median age: 33 years) were included. Late gadolinium enhancement (LGE) was detected within the interventricular septum (IVS) in all patients. The mean T1, T2, and extracellular volume (ECV) values showed similar distribution patterns to LGE. In an exploratory post-hoc age stratification based on the cohort median age of 33 years, we observed that several quantitative CMR parameters (mean ECV, minimum ECV, maximum ECV, mean T1, maximum T1, and minimum T2) were numerically higher in the older subgroup (p < 0.05). Myocardial injury was widespread in patients with severe myocarditis receiving ECMO. Conclusions: Survivors of severe myocarditis who required ECMO support presented diffuse myocardial injury as the dominant pattern on early post-weaning CMR examination, with the interventricular septum showing notably prominent lesions among all myocardial segments. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12880-026-02614-7.
SN - 1471-2342
ER -