Prognostic value of cardiovascular magnetic resonance in acute myocarditis: a systematic literature review and meta-analysis of late gadolinium enhancement and narrative literature review of parametric mapping.
5 affiliations
- 1Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Santariskiu st. 2, Vilnius, 08661, Lithuania. [email protected].
- 2Faculty of Mathematics and Informatics, Institute of Applied Mathematics, Vilnius University, Naugarduko str. 24, Vilnius, LT-03225, Lithuania.
- 3Vilnius University Hospital Santaros Klinikos, Santariskiu st. 2, Vilnius, 08661, Lithuania.
- 4Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Santariskiu st. 2, Vilnius, 08661, Lithuania.
- 5Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariskiu st. 2, Vilnius, 08661, Lithuania.
Abstract
Background and aims
Limited data exist on the prognostic value of parametric mapping and late gadolinium enhancement (LGE) in patients with acute myocarditis (AM). This meta-analysis aimed to investigate the prognostic value of LGE as assessed by using cardiovascular magnetic resonance (CMR) in patients with AM, including more recent evidence. Additionally, the prognostic value of CMR parametric mapping was narratively reviewed.Materials and methods
The systematic search was conducted in the PubMed and Scopus databases from inception to January 17, 2026 (PubMed) and January 20th 2026 (Scopus). 1296 records were found through the search. Finally, sixteen studies were included in this systematic review. Thirteen studies were included in the meta-analysis on association between LGE and clinical outcomes in AM. The composite endpoint was defined as MACE and/or one of the following endpoints: all-cause death, heart failure decompensation requiring hospitalization, heart transplantation, and recurrent AM. MACE was defined as a composite of cardiovascular death (including sudden death), sustained ventricular tachycardia, ventricular fibrillation, complete atrioventricular heart block requiring a pacemaker, and cardiogenic shock. Five studies were reviewed for the prognostic value of parametric mapping parameters. After initial calculations, it appeared that studies using broader composite endpoints than only MACE introduced substantial heterogeneity. Therefore, we have additionally conducted analysis incorporating only eight studies with MACE as the endpoint.Results
The presence of LGE was associated with higher odds of the composite endpoint. The unadjusted pooled OR demonstrated a significant relationship between the presence of LGE and higher chances of the composite endpoint (ORLGE(+) vs. LGE(-)[95% CI] = 3.02 [1.40, 6.51], p < 0.001) with high heterogeneity (I² = 81.98%, p < 0.0001) On the qualitative level, results obtained in the MACE studies subgroup remained the same (ORLGE(+) vs. LGE(-)[95% CI] = 2.88 [2.01, 4.13], p < 0.0001). No clear evidence of publication bias was detected; however, power to detect small-study effects is limited and results should be interpreted cautiously. The prognostic value of parametric mapping parameters did not undergo meta-analysis and was reviewed narratively due to the shortage of the respective data. The data on the prognostic value of native T1, T2, and extracellular volume (ECV) are controversial and limited.Conclusions
Based on the findings, the presence of LGE appears to be associated with an adverse prognosis in patients with AM. However, these findings should be interpreted with caution because of substantial heterogeneity among studies and the unadjusted effect estimations. Evidence regarding the prognostic value of CMR-derived parametric mapping remains limited. Large, prospective, well-designed studies are needed to determine the incremental prognostic value of parametric mapping beyond LGE for risk stratification and outcome prediction in patients with AM.
Related
- Prognostic Impact of Late Gadolinium Enhancement on Major Adverse Cardiovascular Events and Time‐Varying Attenuation of Risk in Dilated Cardiomyopathy
- Cardiovascular outcomes and acute human metapneumovirus infection in adults: A systematic literature review
- The Evolving Phenotype of Myocarditis: The Role of Cardiovascular Magnetic Resonance from Acute Injury to Healing and Residual Scar
- Predictive value of cardiac magnetic resonance atrial and ventricular strain for adverse prognosis in patients with myocarditis: a systematic review and meta-analysis
- Associated factors for in-hospital mortality in patients with fulminant myocarditis: a systematic review and meta-analysis
BibTeX
@article{gaizauskiene2026prognostic,
title = {{Prognostic value of cardiovascular magnetic resonance in acute myocarditis: a systematic literature review and meta-analysis of late gadolinium enhancement and narrative literature review of parametric mapping.}},
author = {Karolina Gaizauskiene and Viktor Skorniakov and Dovile Silinskiene and Nomeda Valeviciene and Sigita Glaveckaite},
journal = {BMC medical imaging},
year = {2026},
month = jul,
doi = {10.1186/s12880-026-02623-6},
url = {https://europepmc.org/article/MED/42972295},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic value of cardiovascular magnetic resonance in acute myocarditis: a systematic literature review and meta-analysis of late gadolinium enhancement and narrative literature review of parametric mapping.
AU - Karolina Gaizauskiene
AU - Viktor Skorniakov
AU - Dovile Silinskiene
AU - Nomeda Valeviciene
AU - Sigita Glaveckaite
PY - 2026
DA - 2026/07/31
JO - BMC medical imaging
DO - 10.1186/s12880-026-02623-6
UR - https://europepmc.org/article/MED/42972295
AB - Background and aims Limited data exist on the prognostic value of parametric mapping and late gadolinium enhancement (LGE) in patients with acute myocarditis (AM). This meta-analysis aimed to investigate the prognostic value of LGE as assessed by using cardiovascular magnetic resonance (CMR) in patients with AM, including more recent evidence. Additionally, the prognostic value of CMR parametric mapping was narratively reviewed.Materials and methods The systematic search was conducted in the PubMed and Scopus databases from inception to January 17, 2026 (PubMed) and January 20th 2026 (Scopus). 1296 records were found through the search. Finally, sixteen studies were included in this systematic review. Thirteen studies were included in the meta-analysis on association between LGE and clinical outcomes in AM. The composite endpoint was defined as MACE and/or one of the following endpoints: all-cause death, heart failure decompensation requiring hospitalization, heart transplantation, and recurrent AM. MACE was defined as a composite of cardiovascular death (including sudden death), sustained ventricular tachycardia, ventricular fibrillation, complete atrioventricular heart block requiring a pacemaker, and cardiogenic shock. Five studies were reviewed for the prognostic value of parametric mapping parameters. After initial calculations, it appeared that studies using broader composite endpoints than only MACE introduced substantial heterogeneity. Therefore, we have additionally conducted analysis incorporating only eight studies with MACE as the endpoint.Results The presence of LGE was associated with higher odds of the composite endpoint. The unadjusted pooled OR demonstrated a significant relationship between the presence of LGE and higher chances of the composite endpoint (ORLGE(+) vs. LGE(-)[95% CI] = 3.02 [1.40, 6.51], p < 0.001) with high heterogeneity (I² = 81.98%, p < 0.0001) On the qualitative level, results obtained in the MACE studies subgroup remained the same (ORLGE(+) vs. LGE(-)[95% CI] = 2.88 [2.01, 4.13], p < 0.0001). No clear evidence of publication bias was detected; however, power to detect small-study effects is limited and results should be interpreted cautiously. The prognostic value of parametric mapping parameters did not undergo meta-analysis and was reviewed narratively due to the shortage of the respective data. The data on the prognostic value of native T1, T2, and extracellular volume (ECV) are controversial and limited.Conclusions Based on the findings, the presence of LGE appears to be associated with an adverse prognosis in patients with AM. However, these findings should be interpreted with caution because of substantial heterogeneity among studies and the unadjusted effect estimations. Evidence regarding the prognostic value of CMR-derived parametric mapping remains limited. Large, prospective, well-designed studies are needed to determine the incremental prognostic value of parametric mapping beyond LGE for risk stratification and outcome prediction in patients with AM.
SN - 1471-2342
ER -