Acute myocarditis: prognostic role of speckle tracking echocardiography and comparison with cardiac magnetic resonance features

Sperlongano, Simona; D’Amato, Andrea; Tagliamonte, Ercole; Russo, Vincenzo; Desiderio, Alfonso; Ilardi, Federica; Muscogiuri, Giuseppe; Esposito, Giovanna; Esposito, Giovanni; D’Andrea, Antonello

doi:10.1007/s00380-021-01893-0

Cited by 13 publications

(17 citation statements)

References 21 publications

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“…GLS in myocarditis resulted to be predictive of non-sustained ventricular tachycardias (cut-off value ≥ 12%) and was significantly lower in patients with myocarditis and cardiovascular events (arrhythmias, HF, cardiogenic shock, and syncope) during hospitalization ( 96 ).…”

Section: Predictors Of Arrhythmias In Myocarditis From Cardiac Imagingmentioning

confidence: 99%

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Sozzi

Gherbesi

Faggiano

et al. 2022

Front. Cardiovasc. Med.

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Myocarditis is an inflammatory disease of the myocardium with focal or diffuse involvement. Viral infections are the most common cause of myocarditis, especially in Western countries. A recent viral illness with gastroenteric or upper respiratory symptoms often precedes myocarditis. The absence of specific pathognomonic features in conjunction with the wide spectrum of clinical manifestations that range from subclinical cases to sudden cardiac death (SCD) makes myocarditis diagnosis particularly challenging. Moreover, myocarditis might represent a cause of initially unexplained dilated cardiomyopathy (DCM) and heart failure (HF), especially among children and young adults. Cardiac magnetic resonance imaging (CMR) is crucial for myocarditis diagnosis, because of its ability to detect interstitial edema during acute inflammation. Assessment of subepicardial or mid-myocardial fibrosis by late gadolinium enhancement (LGE) is typical for myocarditis. Cardiac arrhythmias are frequent events that may arise especially in more severe myocarditis cases. The most common form of arrhythmia is atrial fibrillation, followed by ventricular tachycardia. Documented arrhythmias have been reported more commonly with HIV myocarditis than other more common infections such as Adenovirus, Parvovirus B19, human Herpes virus 6, and Enterovirus. The mechanisms of arrhythmogenesis in myocardial inflammation are not fully understood; in the acute phase, the spectrum of arrhythmogenesis ranges from a direct effect on cardiomyocytes that leads to electrical instability and ion channel impairment to ischemia from coronary macro- or microvascular disease. In chronic myocarditis, instead, myocardial replacement with fibrosis promotes scar-mediated re-entrant ventricular arrhythmias. Observational data suggested the important role of CMR, with LGE being the strongest independent predictor of SCD, cardiac, and all-cause mortality. In acute myocarditis, the most common localization of subepicardial LGE dwells in the lateral wall. Patients with myocarditis that develop HF and arrhythmias usually show a larger LGE distribution involving several myocardial segments. Moreover, a mid-layer LGE in the interventricular septum is more frequent in acute myocarditis than in acute coronary syndromes cases. The risk of SCD in patients with wide areas of LGE is significant, and a shared decision-making approach is warranted. Nevertheless, there is no formal consensus about the extension of LGE to justify implantable cardioverter defibrillator (ICD) implantation in primary prevention.

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Section: Predictors Of Arrhythmias In Myocarditis From Cardiac Imagingmentioning

confidence: 99%

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Sozzi

Gherbesi

Faggiano

et al. 2022

Front. Cardiovasc. Med.

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“…Global longitudinal strain is usually associated with adverse outcomes, especially in patients with myocarditis ( 46 ), heart failure ( 47 ), or cardiomyopathy ( 48 ). GLS may be a clinical predictor for MIS-C.…”

Section: Discussionmentioning

confidence: 99%

Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis

Liu

Song

2022

Front. Pediatr.

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BackgroundNearly 6,000 multisystem inflammatory syndrome in children (MIS-C) have been reported in the United States by November 2021. Left ventricular global myocardial strain has been proved to be one of the best evidence of the diagnostic and prognostic implications for cardiac dysfunction. The global myocardial strain change of MIS-C in the acute phase was still unclear.MethodsPubMed and other sources were searched. A network meta-analysis was conducted. MIS-C was divided into two groups according to left ventricular ejection fraction (LVEF): MIS-C with depressed ejection fraction (MIS-C dEF) and MIS-C with preserved ejection fraction (MIS-C pEF). Global longitudinal strain (GLS) and global circumferential strain (GCS) were compared among MIS-C, Kawasaki disease (KD), and healthy children.ResultsIn total, nine case-control studies were included, published between 2014 and 2021. These studies involved 107 patients with MIS-C, 188 patients with KD, and 356 healthy children. After Bayesian analysis, MIS-C dEF group was found to have a lower LVEF, higher GLS and GCS than the KD groups. Both MIS-C pEF and KD had similar GLS and GCS, which were higher than healthy controls. There was no difference of LVEF among MIS-C pEF, KD, and healthy controls.ConclusionMIS-C dEF was more severe than KD, both in LVEF and global myocardial strain. MIS-C pEF and KD were similar with mild impaired left ventricular myocardial strain compared with the healthy children. Global myocardial strain may be a monitoring index for MIS-C.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021264760].

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“…When myocarditis is presented with chest pain, electrocardiographic changes with ST-segment deviation, raised cardiac troponin levels, differentiation from myocardial infarction (MI) is necessary [ 9 – 11 ]. Echocardiography findings including global ventricular dysfunction, regional wall motion abnormalities or diastolic dysfunction are also non-specific [ 6 , 10 ]. Thus, a coronary angiography has been still performed in patients with inflammatory heart diseases in order to exclude obstructive coronary artery disease (CAD) [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, a coronary angiography has been still performed in patients with inflammatory heart diseases in order to exclude obstructive coronary artery disease (CAD) [ 8 , 10 ]. A final diagnosis of myocarditis is possible only on endomyocardial biopsy (EMB), which is still the diagnostic gold standard but due to its invasive character, low availability and small numbers of multidisciplinary teams with complementary competences in EMB procedure, extremely limited in clinical practice [ 6 , 7 , 10 , 12 – 14 ]. Hence, cardiac magnetic resonance imaging (CMR) has recently emerged as a reference standard for the diagnosis of acute myocarditis due to its ability to identify myocardial oedema and inflammation, as well as scarring associated with MI [ 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hence, cardiac magnetic resonance imaging (CMR) has recently emerged as a reference standard for the diagnosis of acute myocarditis due to its ability to identify myocardial oedema and inflammation, as well as scarring associated with MI [ 15 – 17 ]. It seems to be reasonable to first use CMR as a non-invasive tool for the tissue characterization of the myocardium in clinically stable patients presented with chest pain, ST segment elevation in electrocardiogram (ECG) and normal coronary arteries [ 6 , 18 ]. However, CMR is expensive and not always available in many areas worldwide [ 6 , 8 , 10 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Acute myocarditis: prognostic role of speckle tracking echocardiography and comparison with cardiac magnetic resonance features

Cited by 13 publications

References 21 publications

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications

Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis

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

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