Speckle tracking echocardiography in a patient with viral myocarditis and acute myocardial infarction

Tünnemann-Tarr, Adrienn; Stöbe, Stephan; Laufs, Ulrich; Hagendorff, Andreas; Tayal, Bhupendar

doi:10.1016/j.jccase.2020.06.011

Cited by 9 publications

(14 citation statements)

References 21 publications

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“…In several case reports, speckle tracking is described as a useful tool to diagnose AM [22][23][24][25]. However, CMR is still the gold standard to diagnose AM according to Lake Louise criteria and T1-/T2-mapping [17,18].…”

Section: Detection Of Acute Myocarditis By Echocardiographymentioning

confidence: 99%

Echocardiographic characteristics of patients with SARS-CoV-2 infection

et al. 2020

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Background Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. Results and methods An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals ( n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment ( n = 10/14 patients, 71%). This pattern reminded of a “reverse tako-tsubo” morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal ( n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation ( n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment ( n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern ( n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole ( n = 8/14 patients, 57%). Conclusion Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort—even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.

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Section: Detection Of Acute Myocarditis By Echocardiographymentioning

confidence: 99%

Echocardiographic characteristics of patients with SARS-CoV-2 infection

et al. 2020

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“…Clinical cases presented pathological 2DSTE findings in various diseases documenting the potential use of analyzing RS, CS, LV rotation and twist to detect myocardial pathologies [ 17 , 19 , 20 , 37 , 38 ]. With respect to this challenge high requirements on image quality have to be considered beside standardization of image acquisition [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The early diagnosis of acute myocarditis with normal or preserved LV ejection fraction might be one important target of CS and LV rotation analysis by 2DSTE. However, the patterns of myocarditis are obviously very heterogenoeous with respect to territorial as well as layer-specific involvement making the diagnosis more difficult using TTE [ 19 , 20 , 22 , 23 ]. The echocardiographic detection of myocarditis might be of particular interest in special patient cohorts like athletes or professionals for passenger transport [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…for viral myocarditis [24,39]. Despite the small amount of LV thickening by the outer LV layers the analysis of CS by 2DSTE was described as an useful tool to detect LV pathiologies [40][41][42]-especially LV involvement due to acute myocarditis [19][20][21][22][23]. The early diagnosis of acute myocarditis with normal or preserved LV ejection fraction might be one important target of CS and LV rotation analysis by 2DSTE.…”

Section: The Rationale To Focus On Cs Rs and LV Rotation And Layer-smentioning

confidence: 99%

“…athletes, and patients without obesity and/or pulmonary diseases. The feasibility of 2DSTE, however, should be proven for the analysis of RS, CS, and LV rotation, which might be presumably important for the detection of myocardial involvement in acute myocarditis, which predominantly affects the outer LV layers being responsible for the rotational LV motion [19][20][21][22][23][24][25]. To ensure the detection of functional abnormalities of LV rotational deformation due to myocardial inflammation, standardization of image acquisition and postprocessing analysis by 2DSTE is obviously required.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of left ventricular rotational deformation by 2D speckle tracking echocardiography: a feasibility study in athletes

Hofrichter

Hagendorff

Laufs

et al. 2021

Int J Cardiovasc Imaging

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Abstract2D speckle tracking echocardiography (2DSTE) is established to analyse left ventricular (LV) longitudinal function. The analysis of LV rotational deformation is challenging and requires standardization of image acquisition as well as postprocessing analysis. The aim of this study was to test the feasibility to analyse LV rotational deformation using 2DSTE by introducing a novel algorithm for the detection of artefacts. The study was performed in 20 healthy subjects serving as a control group and in 53 competitive sportsmen. Circumferential, radial strain (CS, RS) and LV rotation were analysed by 2DSTE in parasternal short axis views. The stepwise algorithm to exclude potential artefacts starts with the visual estimation of the image quality with respect to complete visualization of all myocardial segments during the entire cardiac cycle followed by the exclusion of data sets in participants with conduction abnormalities. The next step is the optimization of tracking areas and a cross-check of implausible strain waveforms in multiple acquired comparable cineloops. The last step is the exclusion of strain curves with persisting implausible waveforms if standardization failures and incorrect LV wall tracking are fixed. Plausible physiological strain curves were observed in 89% (n = 65/73) of all subjects. In controls all implausible waveforms could be verified as artefacts. The algorithm was applied in 53 professional athletes to test and confirm its feasibility. Abnormal CS waveforms were documented in 25 athletes, verified as artefacts due to tracking failures in 22 athletes and due to incorrect image acquisition in 3 athletes. CS artefacts were mostly located in the basal posterior and lateral LV segments. (endocardial: 6%, n = 4/70; p < 0.05) and basal posterior (endocardial: 8%, n = 5/70; p < 0.05) segments were highly susceptible to artefacts. 2DSTE of parasternal short axis views to analyse circumferential and radial deformation as well as LV rotation is feasible in athletes. The proposed algorithm helps to avoid artefacts and might contribute to standardization of this technique. 2DSTE might provide an interesting diagnostic tool for the detection of viral myocarditis, e.g. in athletes.

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