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Introduction: Cardiac magnetic resonance (CMR) has excellent diagnostic accuracy in patients with suspected myocarditis. The role of CMR-assessed strain (using feature tracking; FT) in myocarditis assessment is evolving. Methods: We included consecutive patients with clinical suspicion of acute myocarditis referred for CMR between 2012 and 2017. We compared patients with confirmed diagnosis of acute myocarditis (n=59, age 40±15, 59% male), patients in whom myocarditis was excluded (n=28, age 40±13, 55% male), and age- and gender-matched controls with normal CMR (n=59). We quantified myocardial mechanics using FT-strains and T1 mapping using dedicated software. Investigators were blinded to clinical data. The primary endpoint was MACE: death, cardiac rehospitalization, or implantation of ICD-CRT-LVAD. Results: Patients with myocarditis exhibited more impaired longitudinal strain (FT-LS) than those without (14.8±5.6 vs 21.9±2.9 ms, p<0.01) or controls (14.8±5.6 vs 23.4±2.7 ms, p<0.01). FT-LS was not different between the latter two groups. Myocarditis patients in the worse tertile of LS showed more severity of myocarditis than those in the best tertile (Table): longer hospitalization, more use of diuretic and inotropic drugs, more severe cardiac damage (as reflected by higher peak TnI and BNP, and shorter post-contrast T1 time), worse baseline systolic and diastolic function, and worse recovery of LVEF at follow up. Over a mean follow up of 30±15 months, 23 patients reached the primary endpoint. FT-LS >-11.5% was predictive of the primary endpoint (sensitivity 78%, specificity 90%, area under the curve 0.82). In multivariate analysis, LS was an independent predictor of MACE even after adjusting for initial LVEF and TnI (HR 3.38, [2.05-4.84], p<0.01). Conclusions: CMR-derived LS using FT is an independent predictor of adverse cardiovascular outcome, and is thus an effective tool to evaluate the severity and prognosis of patients with acute myocarditis. [ABSTRACT FROM AUTHOR]

Background: The Fontan operation has provided life-saving palliation and adult survival for individuals born with single ventricle physiology. Many now seek advice about safe pregnancy. Little data are, however, available, consisting mainly of anecdotal experience and small series. This article seeks to review the published literature and identify lessons learnt from this collective experience.Methods and Results: We conducted a systematic review to evaluate maternal and fetal outcomes of pregnancy in women with a Fontan circulation. Among 1150 studies that were screened, 6 studies had sufficient longitudinal data points to qualify for meaningful inclusion, yielding 255 pregnancies in 133 women after Fontan procedure resulting in 115 live births (45%; including reports from 1986 to 2015). There was a total of 137 pregnancy losses (69%), with 115 miscarriages (45%), 19 elective terminations of pregnancy (7%), 2 stillbirths (1%), and 1 ectopic pregnancy (1%).The most common cardiovascular adverse events were supraventricular arrhythmia affecting 8.4% (range, 3%-37%) and heart failure affecting 3.9% (range, 3%-11%) of pregnancies. These complications were successfully managed with conventional approaches. No maternal deaths were reported. Postpartum hemorrhage was the predominant obstetric complication affecting 14% of the patients. Most patients were on antiplatelet agents (27%) or anticoagulants (50%) whereas only a minority (11%) were on neither. Among the 115 live births, 68 were premature (59%), 17 were small for gestational age (20%), and neonatal death occurred in 6 patients (5%).Conclusions: The most commonly reported cardiovascular complications in patients with Fontan physiology-associated pregnancy were arrhythmia and heart failure. Miscarriages were highly prevalent as was prematurity and intrauterine growth restriction. Postpartum hemorrhage seems to be the most common obstetric complication. Large-scale data sets are needed to confirm these early observations and address the late sequelae of pregnancy in women with a Fontan circulation. [ABSTRACT FROM AUTHOR]