The incidence of myocarditis was estimated at ~ 22/100,000 patients annually before the COVID-19 pandemic. A large proportion of such patients develop cardiomyopathy with heart failure symptoms, associated with adverse outcomes. Since the beginning of the pandemic, this number increased, both due to SARS COVID infections as well as due to vaccination-induced myocarditis, the latter especially in young men receiving mRNA-related vaccines. Clinical symptoms of myocarditis, irrespectively of the underlying etiology are angina, dyspnea, and fatigue. In addition, malignant arrhythmias causing sudden cardiac death are feared, especially in younger individuals.
Based on current guidelines, cardiac magnetic resonance (CMR) plays a central role in the diagnosis of myocarditis, whereas endomyocardial biopsy is rather reserved for selected patients due to its invasive character. CMR is an established non-invasive imaging technique, aiding the diagnosis of myocarditis by (i) late gadolium enhancement (LGE), which provides evidence of focal fibrosis or oedema due to inflammation, (ii) T1 mapping, which provides evidence of diffuse fibrosis of the extracellular space and (iii) T2 mapping, which provides evidence of myocardial edema and possibly inflammatory activity due to myocarditis. In addition, myocardial strain by feature tracking imaging or strain-encoded MR (SENC) may shed light on myocardial injury, detecting altered myocardial deformation patterns such as reduced strain or dyssynchrony in such patients.
The role of CMR together with other non-invasive cardiovascular imaging techniques, such as echocardiography or cardiac computed tomography needs to be revisited within the COVID pandemic era for the diagnosis of acute myocarditis. Such imaging techniques may not only aid diagnostic classification and risk stratification of such patients but may also influence important clinical decisions, such as tailoring heart failure therapy, indication for ICD or wearable CD, duration of immobilization, and time point for return to work or play.
In this Research Topic, we invite articles reporting novel findings from the field of cardiovascular imaging, especially CMR for the diagnosis and clinical management of patients with viral, COVID-19, or post-vaccination myocarditis. Articles published in this issue will provide an overview of the current technical aspects, indications, and pitfalls, and open new horizons with cardiovascular imaging in this field.
The incidence of myocarditis was estimated at ~ 22/100,000 patients annually before the COVID-19 pandemic. A large proportion of such patients develop cardiomyopathy with heart failure symptoms, associated with adverse outcomes. Since the beginning of the pandemic, this number increased, both due to SARS COVID infections as well as due to vaccination-induced myocarditis, the latter especially in young men receiving mRNA-related vaccines. Clinical symptoms of myocarditis, irrespectively of the underlying etiology are angina, dyspnea, and fatigue. In addition, malignant arrhythmias causing sudden cardiac death are feared, especially in younger individuals.
Based on current guidelines, cardiac magnetic resonance (CMR) plays a central role in the diagnosis of myocarditis, whereas endomyocardial biopsy is rather reserved for selected patients due to its invasive character. CMR is an established non-invasive imaging technique, aiding the diagnosis of myocarditis by (i) late gadolium enhancement (LGE), which provides evidence of focal fibrosis or oedema due to inflammation, (ii) T1 mapping, which provides evidence of diffuse fibrosis of the extracellular space and (iii) T2 mapping, which provides evidence of myocardial edema and possibly inflammatory activity due to myocarditis. In addition, myocardial strain by feature tracking imaging or strain-encoded MR (SENC) may shed light on myocardial injury, detecting altered myocardial deformation patterns such as reduced strain or dyssynchrony in such patients.
The role of CMR together with other non-invasive cardiovascular imaging techniques, such as echocardiography or cardiac computed tomography needs to be revisited within the COVID pandemic era for the diagnosis of acute myocarditis. Such imaging techniques may not only aid diagnostic classification and risk stratification of such patients but may also influence important clinical decisions, such as tailoring heart failure therapy, indication for ICD or wearable CD, duration of immobilization, and time point for return to work or play.
In this Research Topic, we invite articles reporting novel findings from the field of cardiovascular imaging, especially CMR for the diagnosis and clinical management of patients with viral, COVID-19, or post-vaccination myocarditis. Articles published in this issue will provide an overview of the current technical aspects, indications, and pitfalls, and open new horizons with cardiovascular imaging in this field.
