Acute coronary syndrome versus acute myocarditis in young adults–value of speckle tracking echocardiography

Abstract

Purpose Comparing myocarditis with an acute coronary syndrome (ACS)-like presentation and acute myocardial infarction (AMI) poses an important clinical challenge. The purpose of the study was to investigate the diagnostic value of the clinical, laboratory and especially echocardiographic characteristics including speckle tracking echocardiography (STE) of patients with ACS-like myocarditis and AMI. Methods We conducted a retrospective analysis comparing 69 symptomatic patients (≤ 45 years old), hospitalized at the Department of Interventional Cardiology (Medical University of Lodz, Poland) between April 2014 and June 2021 with an initial diagnosis of ST-segment elevation myocardial infarction. Results 37 patients with the cardiac magnetic resonance–confirmed acute myocarditis and 32 patients diagnosed with AMI based on the clinical presentation, electrocardiogram and the presence of a culprit lesion on the coronary angiography were analysed including echocardiography parameters. On STE analysis an average global longitudinal (GLS), radial and circumferential strain including three—layers observation were significantly lower (absolute value) in patients with AMI versus acute myocarditis (p<0.05). There was no significant difference in Endo/Epi ratio (p = 0.144) between the groups. An average GLS < (-17.5) represented the optimal cut-off value for the myocarditis diagnosis. Conclusion In patients with AMI a significant reduction of global and three-layers strains compared to patients with myocarditis was detected. Furthermore, our analysis also confirmed the discriminative pattern of myocardial injury between the groups.

Immune myocarditis induced by sintilimab therapy: A case report

“…Notably, when considering myocarditis caused by ICIs, it is important to also consider other potential diagnoses, which may include acute coronary syndrome, stress cardiomyopathy and viral myocarditis. These conditions can be challenging to accurately diagnose based solely on clinical presentation (39)(40)(41). Comprehensive coronary CT angiography, invasive coronary angiography, electrocardiogram, infection indicators and patient history can help clinicians make a differential diagnosis.…”

Quantification of hs-Troponin Levels and Global Longitudinal Strain among Critical COVID-19 Patients with Myocardial Involvement

“…This makes cardiac magnetic resonance (CMR) examination the reference standard in diagnosing acute myocarditis. Its application is demonstrated by CMR's ability to identify myocardial edema and inflammation non-invasively [32,37]. The establishment of the diagnosis of myocarditis uses MRI and/or biopsy; however, due to limitations, the use of additional diagnoses using CMR and biopsy could not be performed in our study.…”

“…Our findings showed that most patients had preserved LVEFs, non-dilated LVs, and normal E/A ratios. However, LVEF assessment is less able to show subtle myocardial dysfunction [32]. Therefore, in the assessment of the LV function, we included the GLS assessment, which was indicated by a decrease in the LV function in most of the samples, with a mean of 12.92 + 4.99.…”

“…Ischemic necrosis shows an endocardial strain that can extend to the epicardium that shows a transmural character. Meanwhile, abnormalities in myocarditis show a global or regional ischemic pattern that is limited to the epicardial or mid-wall area [32].…”

Uma abordagem geral da miocardite aguda

“…O diagnóstico final de miocardite só é possível através da EMB, que ainda é o padrão ouro diagnóstico, mas devido ao seu caráter invasivo, baixa disponibilidade e pequeno número de equipes multidisciplinares com competências complementares no procedimento de EMB, extremamente limitado na prática clínica (WIECZORKIEWICZ P, et al, 2022).…”