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. 2020 Aug;10(4):725-737.
doi: 10.21037/cdt-20-221.

Performance of cardiovascular magnetic resonance strain in patients with acute myocarditis

Xiaorong Chen  1   2 , Hongjie Hu  3 , Jiangfeng Pan  2 , Jiner Shu  2 , Yi Hu  2 , Risheng Yu  1
Affiliations

Performance of cardiovascular magnetic resonance strain in patients with acute myocarditis

Xiaorong Chen et al. Cardiovasc Diagn Ther. 2020 Aug.

Abstract

Background: To explore the value of myocardial strain derived from cardiac magnetic resonance (CMR) feature tracking in evaluating left ventricular function in acute myocarditis and its relationship with the left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE).

Methods: A total of 115 cases of clinically suspected acute myocarditis, confirmed by CMR, were collected from two centers and divided into groups with reduced and preserved ejection fraction (EF). Fifty normal volunteers were enrolled as the control group. The myocardial strain analysis was based on feature tracking imaging (FTI).

Results: Compared with the control group, the group with myocarditis and preserved EF showed an increased peak ejecting rate (PER), end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), EDV index (EDVi), ESV index (ESVi), SV index (SVi) and decreased strain indices. In patient with myocarditis, the group with reduced EF showed increased EDV, ESV, LGE, LGE% and decreased strain indices compared to the group with preserved EF. EF showed good correlation with LGE, PSC, PSSRC (r>0.6). Peak strain circumferential (PSC) showed good correlation with LGE (r=0.62). The AUC of PSC was optimal to detect early left ventricular dysfunction in myocarditis patient with preserved EF using a cutoff of -19.72% (sensitivity of 68% and specificity of 88%).

Conclusions: Myocardial strain analysis using CMR FTI can provide information about early ventricular dysfunction in myocarditis patient with preserved EF. PSC showed best diagnostic performance, and correlated with LGE.

Keywords: Myocarditis; feature tracking; late gadolinium enhancement (LGE); left ventricular function; magnetic resonance imaging.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt-20-221). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of study patients recruitment and exclusion. CMR, cardiac magnetic resonance; EGE, early gadolinium enhancement; LGE, late gadolinium enhancement.
Figure 2
Figure 2
Two cases of acute myocarditis: the EF preserved myocarditis (A) patient demonstrated subepicardial LGE (arrowhead) of mid-anterolateral and mid- inferolateral wall, the EF reduced myocarditis patient (D) presented diffuse mid-wall LGE (arrow), the end-systolic circumferential strain (B,E) and curve (C,F) showed the PSC EF reduced myocarditis patient was lower than the PSC of EF preserved myocarditis patient. LGE, late gadolinium enhancement; PSC, peak strain circumferential; EF, ejection fraction.
Figure 3
Figure 3
Comparison of cardiac strains between controls and acute myocarditis patients, EF preserved myocarditis patients and EF reduced myocarditis patients. The differences of PSR, PSC, PSL were all statistically significant. PSR, peak strain radial; PSC, peak strain circumferential; PSL, peak strain longitudinal; EF, ejection fraction.
Figure 4
Figure 4
Correlation between EF and PSC, EF and PSSRC, EF and LGE, LGE and PSC. PSC, peak strain circumferential; PSSRC; peak systolic strain rate circumferential; LGE, late gadolinium enhancement; EF, ejection fraction.
Figure 5
Figure 5
Receiver operating characteristic curves analysis showed PSC (AUC =0.83) did the best diagnostic performance for the differentiation of EF preserved myocarditis and control (A), PSC, PSSRC (AUC =0.91) did the best diagnostic performance for the differentiation of EF reduced myocarditis patients and EF preserved myocarditis patients (B). PSC, peak strain circumferential; PSSRC, peak systolic strain rate circumferential.
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