Understanding Acute Myocarditis in Colombia: Clinical, Imaging, and Etiological Perspectives from a Colombian Multicenter Study

Abstract

Background

Acute myocarditis (AM) exhibits heterogeneous clinical presentations, diverse etiologies, and variable outcomes. In Latin America, particularly Colombia, data remain limited regarding multimodal imaging and etiological evaluation.

Objectives

To characterize the clinical, imaging, and etiological features of AM in a Colombian multicenter cohort.

Methods

We conducted a descriptive cross-sectional study including adults diagnosed with AM at two referral centers in Bogotá, Colombia, between January 2013 and June 2024. Cases identified through ICD-10 codes were included if they met European Society of Cardiology criteria for suspected or confirmed myocarditis. Clinical, laboratory, electrocardiographic, echocardiographic, and cardiac magnetic resonance (CMR) data were extracted, and in-hospital outcomes were assessed. A p-value < 0.05 was considered statistically significant.

Results

A total of 205 patients were included (72.1% male; median age 38 years, IQR 29–53). The most common comorbidities were hypertension (19.5%), active smoking (15.6%), and obesity (15.6%). Chest pain was the predominant presenting symptom (84.9%), followed by dyspnea (37.6%). CMR was performed in 47.8% of patients, with subepicardial or midwall late gadolinium enhancement in 78.6% of those evaluated. An etiological diagnosis was established in 28.8% of cases, most commonly related to SARS-CoV-2 infection and Chagas disease. In-hospital complications included pericarditis (28.8%), acute heart failure (15.1%), and fulminant myocarditis (4.9%). The in-hospital mortality rate was 5.39%.

Conclusions

In this Colombian cohort, AM showed clinical characteristics comparable to global reports, but access to advanced imaging and etiologic testing was limited. Complication and mortality rates remain substantial, underscoring the importance of improving diagnostic workflows and early risk stratification.