Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov;110(11):1792-1800.
doi: 10.1007/s00392-021-01885-0. Epub 2021 Jun 4.

Patients with acute myocarditis and preserved systolic left ventricular function: comparison of global and regional longitudinal strain imaging by echocardiography with quantification of late gadolinium enhancement by CMR

Christine Meindl  1 , Michael Paulus  2 , Florian Poschenrieder  3 , Florian Zeman  4 , Lars S Maier  2 , Kurt Debl  2
Affiliations

Patients with acute myocarditis and preserved systolic left ventricular function: comparison of global and regional longitudinal strain imaging by echocardiography with quantification of late gadolinium enhancement by CMR

Christine Meindl et al. Clin Res Cardiol. 2021 Nov.

Abstract

Background: Conventional transthoracic echocardiography (TTE) does often not accurately reveal pathologies in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEEF). Therefore, we investigated the diagnostic value of two-dimensional (2D) speckle tracking echocardiography compared to late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis and normal global LVEF.

Methods and results: 31 patients (group 1) with the diagnosis of acute myocarditis confirmed by CMR according to the Lake Louise criteria and 20 healthy controls (group 2) were analyzed including global longitudinal strain (GLS) and regional longitudinal strain (RLS) derived by the bull's eye plot. Although preserved LVEF was present in both groups, GLS was significantly lower in patients with acute myocarditis (group 1: GLS - 19.1 ± 1.8% vs. group 2: GLS - 22.1 ± 1.7%, p < 0.001). Compared to controls, lower RLS values were detected predominantly in the lateral, inferolateral, and inferior segments in patients with acute myocarditis. Additionally RLS values were significantly lower in segments without LGE.

Conclusion: In patients with acute myocarditis and preserved LVEF, a significant reduction of GLS compared to healthy subjects was detected. Further RLS adds important information to the localization and extent of myocardial injury.

Keywords: CMR; Myocarditis; Regional longitudinal strain; Speckle tracking.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Example of a bull’s eye plot with reduced GLS (− 17.6%) and segmental abnormalities pronounced in the inferior, inferolateral, and anterolateral segments. b–d Corresponding apical 3 (b), 4 (c) and 2 (d) chamber view with reduced longitudinal strain values
Fig. 2
Fig. 2
A T2STIR CMR image of the same patient as in Fig. 1a–d with edema in the inferior and inferolateral segments. b, c Example of a corresponding CMR long axis (b) and short axis (c) view with LGE in the inferior and inferolateral segments
Fig. 3
Fig. 3
Global longitudinal strain in the control and myocarditis group. Data are shown as Tukey boxplots. ***p < 0.001
Fig. 4
Fig. 4
Regional longitudinal strain of individual segments in the control and myocarditis group. Data are shown as Tukey boxplots.*p < 0.05 **p < 0.01 ***p < 0.001
Fig. 5
Fig. 5
Regional longitudinal strain stratified by LGE-VTS score in cardiac MRI. Data are shown as Tukey boxplots. *p < 0.05 ***p < 0.001
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gore I, Saphir O. Myocarditis; a classification of 1402 cases. Am Heart J. 1947;34(6):827–830. doi: 10.1016/0002-8703(47)90147-6. - DOI - PubMed
    1. Caforio AL, et al. Clinical presentation and diagnosis of myocarditis. Heart. 2015;101(16):1332–1344. doi: 10.1136/heartjnl-2014-306363. - DOI - PubMed
    1. Caspar T, et al. Late detection of left ventricular dysfunction using two-dimensional and three-dimensional speckle-tracking echocardiography in patients with history of nonsevere acute myocarditis. J Am Soc Echocardiogr. 2017;30(8):756–762. doi: 10.1016/j.echo.2017.04.002. - DOI - PubMed
    1. Camastra GS, et al. Late enhancement detected by cardiac magnetic resonance imaging in acute myocarditis mimicking acute myocardial infarction: location patterns and lack of correlation with systolic function. J Cardiovasc Med (Hagerstown) 2007;8(12):1029–1033. doi: 10.2459/JCM.0b013e3281053a83. - DOI - PubMed
    1. Khoo NS, et al. Altered left ventricular tissue velocities, deformation and twist in children and young adults with acute myocarditis and normal ejection fraction. J Am Soc Echocardiogr. 2012;25(3):294–303. doi: 10.1016/j.echo.2011.10.010. - DOI - PubMed

LinkOut - more resources