Strain analysis reveals subtle systolic dysfunction in confirmed and suspected myocarditis with normal LVEF. A cardiac magnetic resonance study

Porcari, Aldostefano; Merlo, Marco; Crosera, Lara; Stolfo, Davide; Barbati, Giulia; Biondi, Federico; Angelis, Giulia De; Paldino, Alessia; Pagnan, Lorenzo; Belgrano, Manuel; Cova, Maria Assunta; Pinamonti, Bruno; Vitrella, Giancarlo; Sinagra, Gianfranco

doi:10.1007/s00392-019-01577-w

Cited by 21 publications

(20 citation statements)

References 46 publications

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“…13,14 In a study by Kostakou et al, 15 it was suggested that in patients with acute myocarditis and normal LV-EF, the left ventricular global longitudinal strain (LV-GLS) is lower than that in a healthy control group. Porcari et al 16 focused on patients with acute myocarditis, normal LV-EF, and negative LLC and showed significantly impaired strain values (including LV and RV) in patients with both suspected and confirmed acute myocarditis (negative and positive LLC, respectively), but the prognostic value was not addressed.…”

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confidence: 99%

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

Chen

Sun

et al. 2021

Magnetic Resonance Imaging

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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

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confidence: 99%

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

Chen

Sun

et al. 2021

Magnetic Resonance Imaging

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“…34 Once images are acquired, specific software are utilized for their postprocessing analysis. 36 In 2009, the original LLC were established and then updated in 2018. The LLC suggest a "2 out of 2" approach in an attempt to increase the accuracy in detecting acute myocarditis.…”

Section: Cmr Prerequisites and Technical Approachmentioning

confidence: 99%

“…Moreover, global CS is more accurate than global LS in characterizing acute myocarditis affecting the RV. 36 Among circumferential, longitudinal, and radial strain (RS), the latter (which represents the shortening of subendocardial longitudinal fibers) usually is the last resulting impaired in a number of different settings. Because of that, RV is important in the last stages of myocarditis but of limited relevance in the early phases of the same.…”

Section: Future Imaging Directions: Myocardial Strainmentioning

confidence: 99%

Emerging Role of Cardiac Magnetic Resonance Imaging in Diagnosing Myocarditis

Caredda

Bassareo

Cau

et al. 2022

Journal of Thoracic Imaging

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Acute myocarditis is a disease affecting the myocardial tissue, which is caused by infections, rheumatic diseases, especially sarcoidosis, or certain therapies. Its diagnosis may be difficult, owing to its variable clinical presentation. In this setting, cardiac magnetic resonance plays a pivotal role in detecting myocardial inflammation through qualitative, semiquantitative, and quantitative parameters, in particular with the new quantitative techniques such as T1 and T2 mapping, combined or not with late gadolinium enhancement evaluation. This is in accordance with the revised Lake Louise criteria. In this review, the emerging role of the new cutting-edge cardiac magnetic resonance imaging techniques in diagnosing myocarditis is extensively presented.

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“…This information needs to be integrated in a multiparametric evaluation, considering traditional as well as novel prognostic indexes. NYHA class, ECG, LVEF, right ventricular function [130], diastolic function [131], mitral regurgitation [132], deformation imaging [133], and serum biomarkers (i.e., NTpro-BNP) are fundamental instruments to stratify the risk of events as they reflect the functional status of patients, the degree of biventricular derangement, the hemodynamic impairment, and the magnitude of neurohumoral activation. The change of these indicators over time along with the ventricular arrhythmic burden is an additional element to consider [134].…”

Section: Cmr In Prognostic Stratificationmentioning

confidence: 99%

Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle

et al. 2020

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Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratification.

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Strain analysis reveals subtle systolic dysfunction in confirmed and suspected myocarditis with normal LVEF. A cardiac magnetic resonance study

Abstract: Number 39 42 Males 33 33 0,98 Age [years] 35 (28-43) 35 (28-43) 0,98 Height [cm]

Cited by 21 publications

References 46 publications

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

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

Emerging Role of Cardiac Magnetic Resonance Imaging in Diagnosing Myocarditis

Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle

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