Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance

Abstract

The aim here was to describe the role of speckle tracking echocardiography (STE), in identifying impairment in systolic function in children and adolescents with focal myocarditis and without reduction in ejection fraction. We describe data from 33 pediatric patients (age 4–17 years) admitted for focal myocarditis, confirmed by cardiac magnetic resonance (CMR), and without impaired ejection fraction and/or wall motion abnormalities. All children underwent Doppler echocardiography examination with analysis of global (G) and segmental longitudinal strain (LS) and CMR for the quantification of edema and myocardial fibrosis. Reduction in LS was defined according to age-specific partition values. At baseline, impaired GLS was present in 58% of patients (n = 19), albeit normal ejection fraction. LS was also regionally impaired, according to the area of higher edema at CMR (i.e. most impaired at the level of the infero-lateral segments as compared to other segments (p < 0.05). GLS impairment was also moderately correlated with the percentage edema at CMR (r = − 0.712; p = 0.01). At follow-up, GLS improved in all patients (p < 0.001), and normal values were found in 13/19 patients with baseline reduction. Accordingly persistent global and regional impairment was still observed in 6 patients. Patients with persistent LS reduction demonstrated residual focal cardiac fibrosis at follow-up CMR. Both global and regional LS is able to identify abnormalities in systolic longitudinal mechanics in children and adolescents with focal myocarditis and normal ejection fraction. The reduction in LS is consistent with edema amount and localization at CMR. Furthermore, LS identifies regional recovery or persistent cardiac function impairment, possibly related to residual focal fibrosis.

Long COVID: Distinction between Organ Damage and Deconditioning

“…Two-dimensional transthoracic echocardiography, including speckle tracking strain analysis, combined with a 12-channel electrocardiogram and myocardial biomarkers appeared to be sufficiently sensitive in the detection of myocardial sequelae. Previous findings support this assumption in the context of myocarditis [18,21,22]. The same is true for body plethysmography, including the diffusion capacity for CO, which has already been described in long COVID syndrome [23,24].…”

Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C)

“…Evaluation of circumferential strain showed impairment in the three inferior regions (inferoseptal, inferior, and inferolateral). Interestingly, a similar pattern of abnormal regional strain has been reported in both pediatric and adult cases of viral myocarditis which has correlated with regions of myocardial edema and fibrosis on cardiac magnetic resonance imaging [22][23][24]. This suggests that some of the patterns of myocardial injury with MIS-C may be similar to that of viral myocarditis, though this would require further investigation with cardiac magnetic resonance imaging or endomyocardial biopsy.…”

Usefulness of a multiparametric evaluation including global longitudinal strain for an early diagnosis of acute myocarditis

“…Moreover, LV GLS outperformed conventional echocardiographic parameters (e.g. LV ejection fraction; LV volumes) in detecting CMRI-confirmed acute myocarditis, as already previously described in other investigations [ 3 , 15 ]. Thus, STE may represent a sensitive tool to identify areas of inflammatory myocardial involvement and to provide a differential diagnosis between acute myocarditis and coronary artery disease, where a typical endocardial-epicardial pattern is present.…”