Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain in Suspected Myocarditis With Preserved LV‐EF: A Comparison Between Patients With Negative and Positive Late Gadolinium Enhancement Findings

Abstract

Background: Late gadolinium enhancement (LGE) is absent in many patients with suspected myocarditis and preserved left ventricular ejection fraction (LV-EF), which poses difficulties in diagnosis and risk stratification. Purpose: To investigate the diagnostic and prognostic value of ventricular myocardial strain in patients with suspected myocarditis, preserved LV-EF, and negative Lake Louis Criteria (LLC) by comparing the findings in LGE negative and LGE positive patients. Study Type: Retrospective. Population: A total of 108 patients with clinically suspected myocarditis who did not satisfy LLC were divided into LGE negative (N = 65) and LGE positive (N = 43) groups. A control group consisted of 50 healthy volunteers. Field Strength/Sequence: Steady-state free precession cine and phase-sensitive inversion recovery segmented gradient echo LGE sequences at 3.0 T. Assessment: Myocardial strain of the ventricles was evaluated by feature tracking, major adverse cardiovascular events (MACE) were assessed during follow-up since the date of magnetic resonance examination. Statistical Tests: Independent-samples t test, Mann-Whitney U test, receiver operating characteristic curve analysis, and Cox proportional hazard regression were performed. A P-value <0.05 was considered statistically significant. Results: Cardiac function and myocardial deformability were impaired in all patients relative to controls. Left ventricularglobal radial (LV-GRS), circumferential (LV-GCS), and longitudinal (LV-GLS) strain had diagnostic value, even in LGE negative patients (sensitivity = 0.446, 0.523, and 0.662; specificity = 0.92, 0.80, and 0.64; AUC = 0.685, 0.675, and 0.648, respectively). After a median follow-up of 530.5 (interquartile range: 168.5-969.25) days, MACE occurred in 18 (16.67%) patients. Right ventricular GLS showed prognostic value in all patients and in LGE negative patients, both in univariable analysis (hazard ratio [HR] 1.049, 95% confidence interval [CI] 1.001-1.099 and HR 1.068, 95% CI 1.011-1.127, respectively) and in multivariable Cox survival analysis. LV-GLS was associated with MACE in LGE positive patients in multivariable Cox survival analysis. Data Conclusion: Myocardial strain provides diagnostic and prognostic value in suspected myocarditis with preserved LV-EF, even in the absence of LGE. Level of Evidence: 3 Technical Efficacy: 2

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

“…The current study found that segmental PLS, PCS, and PRS values were markedly impaired in the edema and LGE positive segments, thus indicating that myocardial injury is more severe in the presence of LGE. These ndings are consistent with that by previous investigations (30,32). Strikingly, even reduced PCS values in edema-only and noninvolved segments can be detected as compared with healthy control segments.…”

“…Compared to global analysis, segmental myocardial strain analysis makes it possible to distinguish the myocardial injury in more detail. Recently, Chen et al (30) has found that even the values of GRS, GCS and GLS were signi cantly lower in the LGE negative (with or without edema) group than that in the control group. Impairment of the myocardial strain was more severe in patients with LGE positive myocarditis.…”

Persistent Cardiac Magnetic Resonance Imaging Findings in a Cohort of Adolescents with Post-Coronavirus Disease 2019 mRNA Vaccine Myopericarditis

“…Strain analysis by CMR also has been shown to have prognostic utility in myocarditis even in the setting of normal LV function[ 10 ]. Strain testing can be performed without use of contrast material and can be particularly useful in situations where contrast administration is challenging or contraindicated.…”

Prognostic Significance of Cardiac Magnetic Resonance in Left Atrial and Biventricular Strain Analysis during the Follow-Up of Suspected Myocarditis

“…Myocardial strain, acquired using the CMR feature tracking (FT) technique, quantifies atrial and ventricular systolic function in different dimensions, with left atrial (LA) and biventricular strains proving to have diagnostic and prognostic significance [ 8 , 9 ]. The prognostic value of ventricular strain has been demonstrated in other cardiac diseases [ 10 , 11 , 12 ] and myocarditis [ 13 , 14 , 15 ]. Luetkens et al [ 16 ] explored the alterations in left and right ventricular strain in the course of acute myocarditis and suggested that initial left ventricular (LV) longitudinal strain may serve as a new parameter for the prediction of functional recovery upon follow-up; however, they did not evaluate LA strain in their study.…”