Speckle tracking imaging in inflammatory heart diseases

Abstract

Accurate diagnosis of acute myocarditis is important for the prognosis and risk stratification of these patients. Cardiac magnetic resonance (CMR) has become a major modality for diagnosis of myocarditis, but not widely available. In this study, we tried to evaluate regional and global longitudinal strain by speckle tracking echocardiography in patients with acute inflammatory myocardial diseases in correlation with CMR. Patients with suspected acute myocarditis were recruited prospectively. Clinical diagnosis was established based on clinical, electrocardiographic, laboratory and conventional echocardiographic data. All patients underwent CMR and repeat echocardiographic examination within 24 h of CMR. Echocardiographic examinations were analyzed offline with speckle tracking imaging software. Thirty-two patients with acute perimyocarditis and myopericarditis were included. Mean age was 29 ± 8, 30 males. All patients presented with chest pain and an abnormal electrocardiogram, in 28 ST elevation was found. Troponin was elevated in 30 and was 0.7 ± 0.5 ng/ml. Creatine kinase was 487 ± 319 U. LVEF was 56 ± 5%. Wall motion abnormalities were present in postero-lateral (53%), and inferior wall (21%). Delayed enhancement on CMR was found in 29 patients. Echocardiographic EF based on speckle tracking imaging correlated with CMR calculated EF. There was a positive correlation between the amplitude of regional strain and delayed enhancement, r = 0.52. Sensitivity and specificity of regional strain for prediction of delayed enhancement was 85 and 73% respectively. Speckle tracking imaging can help in the diagnosis of acute myocarditis when CMR is not readily available. Speckle tracking imaging based EF correlates with CMR calculated LVEF and with global strain.

Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography

“…The locations of the regional LV strain abnormalities were comparable to those described in CMR. Moreover, the locations of the segments with impaired GLS in our patient were similar to those that are characteristic of inflammatory heart diseases [17]. These regional and global LV strain values improved and normalised along with clinical improvement.…”

“…The results of this study also confirmed that myocardial strain derived by both STE and CMR techniques is highly reproducible. The usefulness of the regional LV systolic dysfunction assessed by STE was shown in the study of Leitman et al [17]. This study revealed a high correlation between the regional strain values and the presence of delayed enhancement in the same LV segments in patients with myocarditis/perimyocarditis/myopericarditis.…”

Local myocardial stiffness variations identified by high frame rate shear wave echocardiography

“…Scar detection per se is not the purpose of this method, since it is better done by other imaging modalities. Being able to detect localized variations in tissue stiffness inside the myocardium however would potentially allow a quantitative mapping of the myocardial stiffness [ 37 ] Myocardial ischemia that starts in the inner layer [ 38 ], local inflammatory [ 18 ] or tumoral infiltrates [ 19 ], local deposition of abnormal proteins (focal amyloidosis) would all initially present as normal B-mode images in the echo, despite local stiffness variations, and might thus be missed and left untreated. Myocardial stiffness mapping, that could for example be rendered in color-coded stiffness maps, in a similar manner to that presently used in parenchymatous organs [ 1 ], would potentially allow a highly accessible and harmless method for early diagnosis in some of the conditions mentioned above.…”

“…Differences can be present between different myocardial segments, as would be the case for myocardial infarction scars, but also between different sub-regions within the same segments. Detecting these differences with echocardiography is currently feasible by using strain imaging [18][19][20][21][22], that is able to demonstrate segmental variations in tissue deformability, yet without being able to provide tissue stiffness characterization.…”

Comprometimento Cardíaco na Síndrome de Sweet: Um Achado Raro numa Doença Rara

“…Existe alguma evidência de que a ecocardiografia bidimensional speckle tracking (2D-EST) pode ajudar a suportar o diagnóstico de MA uma vez que o strain longitudinal se correlaciona com a presença de fibrose e edema na RMC e de infiltração linfocitária na biópsia endomiocárdica (BEM). [9][10][11][12] No caso relatado, a presença de SLG reduzido sobretudo à custa dos segmentos médio-basais, ao invés dos médio-apicais (padrão típico de DAC significativa), 13 e a rápida resposta aos corticosteroides…”