Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF

Abstract

Background Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization. Left ventricular peak global longitudinal strain (LV‐GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF. Methods Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013–2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized versus. non‐localized, subepicardial versus midwall. LV‐GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life‐threatening arrhythmias, development of heart failure or of LVEF <50%. Results Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV‐GLS ‐17.3%. CMR was performed at 4 days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, they had lower median LV‐GLS values (−13.9% vs. −17.5%, p = .001). At Kaplan–Meier analysis, impaired LV‐GLS (both considered as > −20% or quartiles), non‐localized and midwall LGE were associated with ACEs. Patients with LV‐GLS ≤−20% did not experience ACEs. LV‐GLS remained associated with ACEs after adjustment for non‐localized and midwall LGE. Conclusion In AM presenting with LVEF ≥50%, LV‐GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort.

Myocardial Function in Fetuses with Congenital Cytomegalovirus Infection

“…A subclinical myocardial dysfunction assessed by GLS in patients with acute myocarditis and normal LVEF might have a prognostic value for cardiovascular adverse events [ 41 ]. Moreover, CMV infection is known to deteriorate many cardiovascular diseases, such as myocarditis, atherosclerosis, hypertension, and transplant vasculopathy [ 42 ].…”

The association of myocardial strain with cardiac magnetic resonance and clinical outcomes in patients with acute myocarditis

“…In patients with preserved ejection fraction, a recent study evaluated 108 patients with suspected AMC who did not meet the definitive criteria and showed that longitudinal strain correlated with events only in patients with late gadolinium enhancement ( 22 ). Following the same line, including only patients with preserved ejection fraction, another retrospective study showed that global longitudinal strain provided independent prognostic value over late gadolinium enhancement characterization ( 23 ). A similar finding was obtained in our study, showing LV longitudinal strain as an independent variable correlated with the patient's prognosis.…”

Filling the gap in epidemiology, management and clinical course of COVID-19 vaccination-related pericarditis

“…Interestingly, the evidence-based therapeutic approach for pericarditis unrelated to vaccination was also effective in vaccine-associated pericarditis, providing a rationale for further studies of therapy in this cohort. Myopericarditis unrelated to vaccination has a long-term benign outcome, especially in the presence of preserved global longitudinal strain 21–23 . In this study, 14 most patients were only briefly admitted to hospital and responded well to standard therapy.…”

“…Myopericarditis unrelated to vaccination has a long-term benign outcome, especially in the presence of preserved global longitudinal strain. [21][22][23] In this study, 14 most patients were only briefly admitted to hospital and responded well to standard therapy. Short-term clinical outcomes have been favourable, without relevant arrhythmias and with rapid complete recovery.…”