Aims To assess the current role of cardiac imaging in the diagnosis, management, and
follow-up of patients with acute myocarditis (AM) through a European Association of
Cardiovascular Imaging survey.Methods and results A total of 412 volunteers from 74
countries responded to the survey. Most participants worked in tertiary centres (56%).
All participants had access to echocardiography, while 79 and 75% had access to cardiac
computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR), respectively.
Less than half (47%) had access to myocardial biopsy, and only 5% used this test routinely.
CMR was performed within 7 days of presentation in 73% of cases. Non-ischaemic late
gadolinium enhancement (LGE, 88%) and high-signal intensity in T2-weighted images
(74%) were the most used diagnostic criteria for AM. CCTA was preferred to coronary
angiography by 47% of participants to exclude coronary artery disease. Systematic
prescription of beta-blockers and angiotensin-converting enzyme inhibitors was reported
by 38 and 32% of participants. Around a quarter of participants declared considering
LGE burden as a reason to treat. Most participants (90%) reported performing a follow-up
echocardiogram, while 63% scheduled a follow-up CMR. The main reason for treatment
discontinuation was improvement of left ventricular ejection fraction (89%), followed
by LGE regression (60%). In two-thirds of participants, the decision to resume high-intensity
sport was influenced by residual LGE.Conclusion This survey confirms the high utilization
of cardiac imaging in AM but reveals major differences in how cardiac imaging is used
and how the condition is managed between centres, underlining the need for recommendation
statements in this topic. Graphical Abstract EACVI survey on cardiovascular imaging
in clinical practice for acute myocarditis patients. CAD, coronary artery disease;
CCTA, cardiac computed tomography angiography; CMR, cardiac magnetic resonance; GLS,
global longitudinal strain; ICCU, intensive cardiac care unit; LVEF, left ventricular
ejection fraction; WMA, wall motion abnormalities.
