Multimodal cardiac imaging shows highest accuracy for myocardial injury detection in heat stroke patients

This retrospective cohort study evaluated 187 heat stroke patients and 20 healthy controls at a single center to assess the diagnostic accuracy of various cardiac imaging approaches for detecting myocardial injury. The study compared a multimodal imaging approach (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion imaging) against a composite clinical reference standard, healthy controls, single modalities, and dual-modality combinations.

Among single modalities, myocardial perfusion imaging showed the highest diagnostic efficacy with an AUC of 0.788, followed by cardiac MRI (AUC 0.721) and echocardiography (AUC 0.648). The combined multimodal approach (echocardiography + cardiac MRI + myocardial perfusion imaging) demonstrated the highest overall diagnostic performance with an AUC of 0.861, sensitivity of 85.7%, specificity of 87.3%, and accuracy of 87.0%. This combination significantly outperformed any single modality or dual-modality combination (P < 0.05).

The study followed patients for 30 days, with a composite clinical endpoint of all-cause death, heart failure, or significant arrhythmia. Safety and tolerability data were not reported. Key limitations include the retrospective design, single-center setting, and lack of reported funding or conflict of interest information. The findings suggest that a multimodal imaging approach may offer improved detection of myocardial injury in heat stroke patients, but prospective validation is needed before clinical implementation.