COVID-19 Myocarditis: Prognostic Role of Bedside Speckle-Tracking Echocardiography and Association with Total Scar Burden

Abstract

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.

Impaired Speckle-Tracking-Derived Left Ventricular Longitudinal Strain Is Associated with Transposition of Great Arteries in Neonates: A Single-Center Study

“…The LVpGLS value proved to be statistically significantly lower in the newborns with TGA than in those in the control group, independent of the BMI value, the EF value and the LV mass, which strengthens the hypothesis that this strain parameter (LVpGLS) can be used to predict the clinical evolution of TGA [19,20].…”

Effectiveness and safety of Linggui Zhugan decoction for the treatment of premature contraction in patients with coronary heart disease: A systematic review and meta-analysis

“…According to statistics, 60% of deaths from cardiovascular disease are due to sudden cardiac death and various kinds of cardiac arrhythmias ( 1 ). Moreover, the symptom of common heart inflammation such as myocarditis can always change from an asymptomatic presentation to a manifestation of arrhythmias ( 2 ). When the signal of premature beat fails to spread downward, cardiac output will be significantly reduced, resulting in symptoms such as dizziness, palpitations, sensation of fast heartbeat, and feeling of weakness ( 3 , 4 ).…”

“…This structural remodeling may eventually result in excitation–contraction couplings disorder, changes in the ion permeability of cardiomyocytes, and obstacles in cardiac excitation conduction ( 20 , 21 ). These disorders can cause the heart unable to maintain regular and coordinated contraction, thus initiating premature contraction, which is characterized by high heart rate as well as the reduction in left ventricular output and cardiac output in clinical examination ( 2 ). Moreover, previous research has proved the significant curative effect of herbal medicine in the treatment of premature contraction ( 22 ), a disease that currently lacks effective medical therapy ( 8 ).…”

Tendentious Paper—Titles and Wrong Conclusions Lead to Fear in the Population and Medical Overconsumption. Comment on Luchian et al. Subclinical Myocardial Dysfunction in Patients with Persistent Dyspnea One Year after COVID-19. Diagnostics 2022, 12, 57

“…If we compare the values of the two groups of patients with these reference values, we see that the values are all within the limits of the normal population. This is expected, as D’Andrea et al demonstrated that global longitudinal strain (GLS) was only pathological in patients with COVID myocarditis and that, in any case, it improved after the administration of the correct therapy [ 4 ].…”