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. 2022 Aug;38(8):1851-1861.
doi: 10.1007/s10554-022-02601-3. Epub 2022 Mar 31.

Impact of myocardial injury on regional left ventricular function in the course of acute myocarditis with preserved ejection fraction: insights from segmental feature tracking strain analysis using cine cardiac MRI

L Weber  1   2 , J M Sokolska  3   4 , T Nadarevic  1   5 , M Karolyi  1 , B Baessler  1 , X Fischer  6 , M Sokolski  3   4 , J von Spiczak  1   7 , M Polacin  1   7 , I Matziris  1 , H Alkadhi  1 , M Robert  8   9   10
Affiliations

Impact of myocardial injury on regional left ventricular function in the course of acute myocarditis with preserved ejection fraction: insights from segmental feature tracking strain analysis using cine cardiac MRI

L Weber et al. Int J Cardiovasc Imaging. 2022 Aug.

Abstract

The aim of this study was to provide insights into myocardial adaptation over time in myocyte injury caused by acute myocarditis with preserved ejection fraction. The effect of myocardial injury, as defined by the presence of late gadolinium enhancement (LGE), on the change of left ventricular (LV) segmental strain parameters was evaluated in a longitudinal analysis. Patients with a first episode of acute myocarditis were enrolled retrospectively. Peak radial (PRS), longitudinal (PLS) and circumferential (PCS) LV segmental strain values at baseline and at follow-up were computed using feature tracking cine cardiac magnetic resonance imaging. The change of segmental strain values in LGE positive (LGE+) and LGE negative (LGE-) segments was compared over a course of 89 ± 20 days. In 24 patients, 100 LGE+ segments and 284 LGE- segments were analysed. Between LGE+ and LGE- segments, significant differences were found for the change of segmental PCS (p < 0.001) and segmental PRS (p = 0.006). LGE + segments showed an increase in contractility, indicating recovery, and LGE- segments showed a decrease in contractility, indicating normalisation after a hypercontractile state or impairment of an initially normal contracting segment. No significant difference between LGE+ and LGE- segments was found for the change in segmental PLS. In the course of acute myocarditis with preserved ejection fraction, regional myocardial function adapts inversely in segments with and without LGE. As these effects seem to counterbalance each other, global functional parameters might be of limited use in monitoring functional recovery of these patients.

Keywords: Cardiac magnetic resonance imaging; Feature tracking strain analysis; Late gadolinium enhancement; Myocardial strain; Myocarditis.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Example of Late Gadolinium Enhancement imaging and feature tracking strain analysis by cardiac magnetic resonance in a patient with acute myocarditis. A representative 4 chamber (A) and a short axis midventricular LGE image (D) show extensive involvement of the lateral left ventricular wall. Longitudinal strain analysis is performed in the long axis view as represented by an enddiastolic (B) and endsystolic 4 chamber slice (C). Circumferential and radial strain analysis is assessed using short axis slices as represented by an enddiastolic (E) and endsystolic (F) midventricular slice
Fig. 3
Fig. 3
Change in segmental strain values from baseline to follow-up. Bars indicate the standardised mean difference (SMD) and error bars their 95% confidence interval. As peak circumferential strain and peak longitudinal strain are expressed as negative percentages, negative SMD indicates increase, positive SMD indicates decrease in contractility. For peak radial strain the inverse is the case. LGE+ Segments with late gadolinium enhancement, LGE− Segments without late gadolinium enhancement
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