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Background and aims <p>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.</p> Materials and methods <p>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.</p> Results <p>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 (OR<sub>LGE(+) vs. LGE(−)</sub>[95% CI] = 3.02 [1.40, 6.51], <i>p</i> &lt; 0.001) with high heterogeneity (I<sup>2</sup> = 81.98%, <i>p</i> &lt; 0.0001) On the qualitative level, results obtained in the MACE studies subgroup remained the same (OR<sub>LGE(+) vs. LGE(−)</sub>[95% CI] = 2.88 [2.01, 4.13], <i>p</i> &lt; 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.</p> Conclusions <p>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.</p>

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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

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Karolina Gaizauskiene,
  • Viktor Skorniakov,
  • Dovile Silinskiene,
  • Nomeda Valeviciene,
  • Sigita Glaveckaite

摘要

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.