Risk Stratification of Cardiomyopathy with Cardiac MRI

Broadcast Message

Cardiac MRI use has increased due to COVID-19 vaccine-related myopericarditis. A study by Dr. Eichhorn summarized 103 studies, finding late gadolinium enhancement (LGE) correlates with higher mortality risk, more significantly than heart damage extent. Normal MRI results (no LGE) in COVID-19 cases suggest lower adverse outcome risk.

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https://petermcculloughmd.substack.com/p/risk-stratification-of-cardiomyopathy

Risk Stratification of Cardiomyopathy with Cardiac MRI Presence of Late Gadolinium Enhancement Predicts Mortality Sun, 29 Sep 2024 09:43:20 GMT https://petermcculloughmd.substack.com/p/risk-stratification-of-cardiomyopathy By Peter A. McCullough, MD, MPH

Use of cardiac magnetic resonance imaging has skyrocketed in the era of COVID-19 vaccine myopericarditis. We have largely relied upon studies of other cardiomyopathies in the pre-pandemic era to gain inferences on how the technology can be used for risk stratification.

Dr. Christian Eichhorn and colleagues summarized 103 studies to date and found that late gadolinium enhancement (LGE) which indicates tissue damage, edema, and scar was associated with the risk of death. The presence or absence of this finding was more impressive than the quantification of how much of the left ventricle was damaged or the resultant reduction in heart pumping function or left ventricular ejection fraction.

Eichhorn C, Koeckerling D, Reddy RK, Ardissino M, Rogowski M, Coles B, Hunziker L, Greulich S, Shiri I, Frey N, Eckstein J, Windecker S, Kwong RY, Siontis GCM, Gräni C. Risk Stratification in Nonischemic Dilated Cardiomyopathy Using CMR Imaging: A Systematic Review and Meta-Analysis. JAMA. 2024 Sep 19. doi: 10.1001/jama.2024.13946. Epub ahead of print. PMID: 39298146.

These data are good news for COVID-19 myopericarditis cases where the cardiac MRI is normal (no LGE). At least from prior studies this group would be at lower risk of adverse outcomes including death.

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Peter A. McCullough, MD, MPH

President, McCullough Foundation