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. 2023 Aug 17;25(1):49.
doi: 10.1186/s12968-023-00957-6.

Predictive value of cardiac magnetic resonance right ventricular longitudinal strain in patients with suspected myocarditis

Benedikt Bernhard  1 , Giulin Tanner  1 , Davide Garachemani  1 , Aaron Schnyder  1 , Kady Fischer  2 , Adrian T Huber  3 , Yasaman Safarkhanlo  2 , Anselm W Stark  2 , Dominik P Guensch  2 , Jonathan Schütze  2 , Simon Greulich  4 , Jessica A M Bastiaansen  3 , Maryam Pavlicek-Bahlo  2 , Dominik C Benz  5 , Raymond Y Kwong  5 , Christoph Gräni  6
Affiliations

Predictive value of cardiac magnetic resonance right ventricular longitudinal strain in patients with suspected myocarditis

Benedikt Bernhard et al. J Cardiovasc Magn Reson. .

Abstract

Background: Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR.

Methods: Patients referred for CMR, meeting clinical criteria for suspected myocarditis and no other cardiomyopathy were enrolled in a dual-center register cohort study. Ejection fraction (EF), GLS and tissue characteristics were assessed in both ventricles to assess their association to first major adverse cardiovascular events (MACE) including hospitalization for heart failure (HF), ventricular tachycardia (VT), recurrent myocarditis and death.

Results: Among 659 patients (62.8% male; 48.1 ± 16.1 years), RV GLS was impaired (> - 15.4%) in 144 (21.9%) individuals, of whom 76 (58%), 108 (77.1%), 27 (18.8%) and 40 (32.8%) had impaired right ventricular ejection fraction (RVEF), impaired left ventricular ejection fraction (LVEF), RV late gadolinium enhancement (LGE) or RV edema, respectively. After a median observation time of 3.7 years, 45 (6.8%) patients were hospitalized for HF, 42 (6.4%) patients died, 33 (5%) developed VT and 16 (2.4%) had recurrent myocarditis. Impaired RV GLS was associated with MACE (HR = 1.07, 95% CI 1.04-1.10; p < 0.001), HF hospitalization (HR = 1.17, 95% CI 1.12-1.23; p < 0.001), and death (HR = 1.07, 95% CI 1.02-1.12; p = 0.004), but not with VT and recurrent myocarditis in univariate analysis. RV GLS lost its association with outcomes, when adjusted for RVEF, LVEF, LV GLS and LV LGE extent.

Conclusion: RV strain is associated with MACE, HF hospitalization and death but has neither independent nor incremental prognostic value after adjustment for RV and LV function and tissue characteristics. Therefore, assessing RV GLS in the setting of myocarditis has only limited value.

Trial registration: ClinicalTrials.gov NCT04774549 NCT03470571.

Keywords: Cardiac magnetic resonance imaging; Feature tracking; Heart failure hospitalizations; Myocarditis; Right ventricle; Right ventricular global longitudinal strain.

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Conflict of interest statement

Dr. Gräni received research funding from the Swiss National Science Foundation, Innosuisse, GAMBIT foundation and from the Center for Artificial Intelligence in Medicine Research Project Fund University Bern, outside of the submitted work. Dr. Bernhard and Dr. Benz report a career development grant from the Swiss National Science Foundation. Ms. Safarkhanlo received research funding from the Center for Artificial Intelligence in Medicine Research Project Fund University Bern, outside of the submitted work. Dr. Huber has received research grants from the Swiss National Science Foundation, the Swiss Academy of Medical Sciences, the Helmut-Hartweg Foundation and the Foundation to Fight against Cancer, all for work outside the submitted study. He has received speaker/consulting honoraria or travel support from Bayer, Bracco and Siemens, all for work outside the submitted study. All other authors report no conflicts.

Figures

Fig. 1
Fig. 1
Study cohort. CMR: cardiac magnetic resonance. Criteria for clinically suspected myocarditis was defined according to Caforio et al. [1]
Fig. 2
Fig. 2
Examples of 6 patients referred to CMR for suspected myocarditis. LGE is marked with red asterisks. LGE images and short-axis slices were acquired in end-diastole (red contours). Blue contours represent the position of end-systolic contours. Strain overlays represent end-systolic peak strain, blue color mirrors more negative strain, while red color represents neutral or positive strain. CAD: coronary artery disease; EF: ejection fraction; GLS: global longitudinal strain; LV: left ventricle, RV: right ventricle
Fig. 3
Fig. 3
Correlation of right ventricular global longitudinal strain to other parameters of right ventricular and left ventricular function. Cut-off values were chosen according to [–18]. BSA: body surface area; EF: ejection fraction; GLS/GRS/GCS: global longitudinal/radial/circumferential strain; EDV: end diastolic volume; LV: left ventricle, RV: right ventricle
Fig. 4
Fig. 4
Crude and adjusted time to event-curves for the association of right ventricular global longitudinal strain and heart failure hospitalizations. CI: confidence intervals, RV GLS: right ventricular global longitudinal strain
See this image and copyright information in PMC

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