Myocarditis and colchicine: a new perspective from cardiac MRI

Background Because of anatomic proximity, myocarditis is often associated with pericarditis. Although randomized trials have not delineated a successful evidence-based therapy for myocarditis, there is evidence of considerable benefit in treating pericarditis with a regimen of colchicine and a non-steroidal anti-inflammatory drug (NSAID). Cardiac MRI (CMR) is capable of detecting both myocarditis and pericarditis using T2 weighted pulse sequences and delayed enhancement imaging with gadolinium. This study was designed to assess the effect of a colchicine/NSAID treatment regimen for myocarditis identified by CMR. Methods An institutional CMR database was queried for all patients with pericarditis who had associated myocarditis. Those patients with at least 1 follow-up CMR study to assess response to therapy with a colchicine/NSAID regimen constituted the study population. The follow-up CMR studies were categorized and tabulated as resolved, partially resolved or no improvement with respect to myocarditis, based on consensus of 2 experienced CMR interpreters.