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European Radiology
Published in: European Radiology 11/2023

05-05-2023 | Myocarditis | Cardiac

Multiparametric cardiac magnetic resonance reveals persistent myocardial inflammation in patients with exertional heat illness

Authors: Song Luo, Shu Tian Xu, Jun Zhang, U. Joseph Schoepf, Akos Varga-Szemes, Charles R. T. Carpenter, Ling Yan Zhang, Yan Ma, Zhe Li, Yang Wang, Wei Wei Huang, Bei Bei Zhi, Wei Qiang Dou, Li Qi, Long Jiang Zhang

Published in: European Radiology | Issue 11/2023

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Abstract

Objectives

To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI).

Methods

This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups.

Results

Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042).

Conclusions

With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI.

Clinical relevance statement

This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients.

Key Points

• EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis.
• ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05).
• EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042).
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Metadata
Title
Multiparametric cardiac magnetic resonance reveals persistent myocardial inflammation in patients with exertional heat illness
Authors
Song Luo
Shu Tian Xu
Jun Zhang
U. Joseph Schoepf
Akos Varga-Szemes
Charles R. T. Carpenter
Ling Yan Zhang
Yan Ma
Zhe Li
Yang Wang
Wei Wei Huang
Bei Bei Zhi
Wei Qiang Dou
Li Qi
Long Jiang Zhang
Publication date
05-05-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2023
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-09706-w

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