Cardiac Magnetic Resonance Feature Tracking Myocardial Strain Analysis in Suspected Acute Myocarditis: Diagnostic Value and Association with Severity of Myocardial Injury

Abstract

Background: Albeit that cardiac magnetic resonance feature tracking (CMR-FT) has enabled quantitative assessment of global myocardial strain in the diagnosis of suspected acute myocarditis, the cardiac segmental dysfunction remains understudied. The aim of the present study was using CMR-FT to assess the global and segmental dysfunction of the myocardium for diagnosis of suspected acute myocarditis.Methods: 47 patients with suspected acute myocarditis (divided into impaired and preserved left ventricular ejection fraction [LVEF] groups) and 39 healthy controls (HCs) were studied. A total of 752 segments were divided into three subgroups, including segments with non-involvement (SNi), segments with edema (SE), and segments with both edema and late gadolinium enhancement (SE+LGE). 272 healthy segments served as the control group (SHCs).Results: Compared with HCs, patients with preserved LVEF showed impaired global circumferential strain (GCS) and global longitudinal strain (GLS). Segmental strain analysis showed that the peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) values significantly reduced in SE+LGE compared with SHCs, SNi, SE. PCS significantly reduced in SNi (-15.3±5.8% vs. -20.3±6.4%, p<0.001) and SE (-15.2±5.6% vs. -20.3±6.4%, p<0.001), compared with SHCs. The area under the curve (AUC) values of GLS (0.723) and GCS (0.710) were higher than that of global peak radial strain (0.657) in the diagnosis of acute myocarditis. Model with updated Lake Louise Criteria could result in a further increase in diagnostic performance.Conclusions: Global and segmental myocardial strain were impaired in patients with suspected acute myocarditis, even in the edema or relatively non-involved regions. CMR-FT may serve as an incremental tool for assessment of cardiac dysfunction and provide important additional imaging-evidence for distinguishing the different severity of myocardial injury in myocarditis.

Вибір Блокатора Ренін-Ангіотензин-Альдостеронової Системи Для Лікування Серцевої Недостатності При Гострому Міокардиті

“…Cardiac magnetic resonance (CMR) imaging with Gadovist® contrast was performed on a Vantage Titan HSR 1.5 Tesla scanner (Toshiba, Japan). Images of the heart were evaluated along the short and long axes in three modes: T1 -(to detect hyperemia in the area of the inflammatory lesion), T2 -(to detect areas of edema) and late gadolinium enhancement (LGE) mode (10-15 minutes after contrast injection to detect necrotic or fibrotic changes) [8,12,13]. The severity of myocardial edema was evaluated, and a quantitative analysis of the areas of contrast accumulation in the early and delayed phases was performed according to the standardised imaging of the 17-segment structure of the LV myocardium with an assessment of the number of segments with inflammatory and fibrotic changes [8,10].…”

Myocarditis in children 2024, new themes and continued questions

“…Recent adult studies have shown correlation between myocarditis diagnosis and echocardiographic global and segmental myocardial strain abnormalities, which gives promise to the possibility of echocardiographic diagnosis and follow-up of myocarditis [58 ▪ ,59]. Strain evaluation by CMR has also shown diagnostic value in myocarditis and may help improve future diagnostic criteria for pediatric myocarditis [60 ▪▪ ,61]. Additionally, positron emission tomography (PET) of increased myocardial metabolic activity has been used to evaluate myocarditis, with suggestion that this technology may provide improved prognostic ability in follow-up evaluations as well as significant utility in myocarditis mediated by systemic inflammatory or rheumatologic disorders [62,63].…”