Acute myocarditis: can novel echocardiographic techniques assist with diagnosis?

Afonso, Luís; Hari, Pawan; Pidlaoan, V. P.; Kondur, Ashok; Jacob, Sony; Khetarpal, Vipin

doi:10.1093/ejechocard/jep183

Cited by 26 publications

(20 citation statements)

References 7 publications

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“…Pericardial effusion was detected by echo in 10.2%, which was lower (20%) than described in patients with biopsy proven myocarditis . Wall motion abnormalities were seen in only 7.1% within our data.…”

Section: Discussioncontrasting

confidence: 59%

Return to sport: First data from the Nationwide German Myocarditis Registry for athletes

et al. 2019

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There is currently no evidence how to treat athletes with suspected or proven myocarditis in the context of “return to sport” (RTS). Addressing this issue, a multi‐centre, web‐based online registry was initiated in 2011 to record athletes presenting with suspected or proven myocarditis. Our nationwide registry is the first successfully implemented database of competitive athletes with suspected or proven myocarditis. Besides baseline data, available clinical data and the physician`s recommendation in terms of sport participation were recorded. A telephone interview for clinical follow‐up was performed one year (1FU) after the initial presentation. 98 athletes (77 males, mean age 30.9 years) were analysed. Data from 1FU were available for 74 athletes. At baseline, 72% of the athletes reported infection‐associated symptoms prior to the first medical contact. A high percentage of athletes present abnormal clinical or technical cardiac findings. Abnormal rest‐ECG was seen in 41/74 athletes, abnormal echo in 37/74, abnormal MRI in 32/74. During the period prior to 1FU, there were no incidences of sudden death or cardiac arrest. Most athletes return to sport within one year, however duration and intensity of training were still reduced in one third of the athletes. A total of 58/74 were fully reintegrated in sport, 10/74 partially, and 5/74 were not able to participate in sport. Greater age was delineated as the only significant predictor for incomplete reintegration after one year. Consequently, even if there is missing evidence regarding how to treat athletes with suspected myocarditis in context of RTS, the chosen approach in terms of diagnostic work‐up and decision regarding RTS seems to be safe. In summary, treating athletes with suspected or proven myocarditis continues to be challenging but register data will help to get a more precise idea how to treat athletes with myocarditis.

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Section: Discussioncontrasting

confidence: 59%

Return to sport: First data from the Nationwide German Myocarditis Registry for athletes

et al. 2019

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“…Lynch et al evaluated mitral annular and velocity vector imaging in acute myopericarditis [24]. Afonso et al stated that strain imaging and real- time myocardial contrast echocardiography supported the detection of regional contractile and perfusion abnormalities in acute myocarditis [25]. Similarly, Escher et al suggested that speckle tracking echocardiography was a useful tool for evaluation acute myocarditis [26].…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of myocardial involvement in acute myopericarditis in young adults

Sarıçam

Saglam

Hazırolan

2017

BMC Cardiovasc Disord

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BackgroundMyocardial involvement in young adults has various causes. Acute myopericarditis is one of the myocardial involvements in young adults. It is easy to confuse with acute ST-elevation myocardial infarction because of the electrocardiographic features. This study aims to investigate a number of imaging techniques and clinical features for acute myopericarditis in young adults (<30 years of age).MethodsThis retrospective study included 147 patients selected from the 2147 patients at the age of <30 with acute chest pain admitted into emergency service between 2010 and 2016. Of 147 patients, 77 patients were diagnosed with acute myopericarditis (group I) (between 18 and 30 aged) and 70 patients had ST-elevation myocardial infarction (group II). The echocardiographic pictures and information of the patients in both groups were rechecked in terms of impaired segmental wall-motion abnormalities, pericardial effusion, and additional features.ResultsThe patients in group I had focal echobright, which was defined as myocardial brightness in the left ventricle regions, especially in posterior and lateral wall. Focal echobright was observed in the 75 of 77 cases of acute myopericarditis in transthoracic echocardiogram. This sign was confirmed by cardiac magnetic resonance imaging. Focal echobright sensitivity was 95%; its specificity was 93%; its predictive was 95.2%. Pericardial effusion (83%) was observed in group I behind posterior wall. Its specificity was 81%; its sensitivity was 65%; predictivity was 73%.ConclusionsPericardial effusion and myocardial focal echobright in echocardiography can be quite sensitive indicators for acute myopericarditis in young adults.

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“…Previous studies of conventional echocardiography in myocarditis have demonstrated a variety of echocardiographic findings, and in addition to systolic dysfunction, regional wall abnormalities, changes in image texture, and pericardial effusion had been reported [19, 30–32]. However, until now, no study has been reported which attempts to distinguish the spectrum of EMB-proven intramyocardial processes.…”

Section: Discussionmentioning

confidence: 99%

New Echocardiographic Findings Correlate with Intramyocardial Inflammation in Endomyocardial Biopsies of Patients with Acute Myocarditis and Inflammatory Cardiomyopathy

Escher

Kasner

Kühl

et al. 2013

Mediators of Inflammation

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Background. The diagnosis of acute myocarditis (AMC) and inflammatory cardiomyopathy (DCMi) can be difficult. Speckle tracking echocardiography with accurate assessments of regional contractility could have an outstanding importance for the diagnosis. Methods and Results. N = 25 patients with clinically diagnosed AMC who underwent endomyocardial biopsies (EMBs) were studied prospectively. Speckle tracking imaging was examined at the beginning and during a mean follow-up period of 6.2 months. In the acute phase patients had markedly decreased left ventricular (LV) systolic function (mean LV ejection fraction (LVEF) 40.4 ± 10.3%). At follow-up in n = 8 patients, inflammation persists, correlating with a significantly reduced fractional shortening (FS, 21.5 ± 6.0%) in contrast to those without inflammation in EMB (FS 32.1 ± 7.1%, P < 0.05). All AMC patients showed a reduction in global systolic longitudinal strain (LS, −8.36 ± −3.47%) and strain rate (LSR, 0.53 ± 0.29 1/s). At follow-up, LS and LRS were significantly lower in patients with inflammation, in contrast to patients without inflammation (−9.4 ± 1.4 versus −16.8 ± 2.0%, P < 0.0001; 0.78 ± 0.4 versus 1.3 ± 0.3 1/s). LSR and LS correlate significantly with lymphocytic infiltrates (for CD3 r = 0.7, P < 0.0001, and LFA-1 r = 0.8, P < 0.0001). Conclusion. Speckle tracking echocardiography is a useful adjunctive assisting tool for evaluation over the course of intramyocardial inflammation in patients with AMC and DCMi.

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Acute myocarditis: can novel echocardiographic techniques assist with diagnosis?

Cited by 26 publications

References 7 publications

Return to sport: First data from the Nationwide German Myocarditis Registry for athletes

Return to sport: First data from the Nationwide German Myocarditis Registry for athletes

Clinical evaluation of myocardial involvement in acute myopericarditis in young adults

New Echocardiographic Findings Correlate with Intramyocardial Inflammation in Endomyocardial Biopsies of Patients with Acute Myocarditis and Inflammatory Cardiomyopathy

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