Subclinical left ventricular dysfunction and correlation with regional strain analysis in myocarditis with normal ejection fraction. A new diagnostic criterion

Kostakou, Peggy; Kostopoulos, V.; Tryfou, E; Giannaris, Vassilis D.; Rodis, Ioannis E.; Olympios, Christoforos; Kouris, Nikos T.

doi:10.1016/j.ijcard.2018.01.058

Cited by 56 publications

(67 citation statements)

References 23 publications

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“…These findings confirmed the high correlation between global strain assessed by both STE and CMR. Similar findings were described by Kostakou et al [18]. This study demonstrated that patients with acute myocarditis, similar to the presented case, had significantly impaired global LV GLS despite having normal LVEF.…”

Section: Discussionsupporting

confidence: 92%

Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography

Uziębło‐Życzkowska

Mielniczuk

Ryczek

et al. 2020

Cardiovasc Ultrasound

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Background: Speckle tracking echocardiography (STE) is an objective, well-validated and reproducible technique of assessing left ventricular longitudinal deformation; it also offers a more sensitive assessment of myocardial contractility than widely used visual estimation. Evaluating global longitudinal strain may help identify patients with subclinical left ventricular systolic dysfunction. Case presentation: We report the case of a 28-year-old man with myocarditis, which successfully diagnosed and followed-up with the novel echocardiography method using speckle tracking imaging. The patient was referred to our hospital with an initial diagnosis of ST-segment elevation myocardial infarction. Transthoracic echocardiography did not show any contractility abnormalities. Hence, in the course of further diagnostics, left ventricular function was assessed by STE. Depressed global longitudinal strain was noted within several segments of the left ventricle. Then, cardiac magnetic resonance imaging was performed to confirm the diagnosis of myocarditis. Conclusions: STE seems to be competitive in relation to cardiac magnetic resonance imaging in the diagnosis of some diseases, such as myocarditis.

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Section: Discussionsupporting

confidence: 92%

Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography

Uziębło‐Życzkowska

Mielniczuk

Ryczek

et al. 2020

Cardiovasc Ultrasound

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“…Thus, it is likely that the true prevalence of cardiac dysfunction is underreported (11). Speckle tracking echocardiography (STE) can rapidly quantify myocardial dysfunction (e.g., using global longitudinal strain [GLS]) with increased sensitivity compared with standard echocardiographic measures (12)(13)(14). More recently, a novel technique to measure LV function based on STE, global myocardial work (MW), was developed (15,16).…”

Section: Introductionmentioning

confidence: 99%

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Minhas

Gilotra

Goerlich

et al. 2021

Front. Cardiovasc. Med.

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Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19.Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >−16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85–0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78–0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE.Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.

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“…CMR or invasive diagnostics, such as myocardial biopsy, are often not feasible in the setting of an acute presentation. It has been shown that 2D echocardiography with strain imaging can help with differential diagnosis and lead to an optimal treatment path for the patient (10,29).…”

Section: Discussionmentioning

confidence: 99%

3D-speckle-tracking echocardiography correlates with CMR diagnosis of acute myocarditis

Goody

Zimmer

et al. 2021

Preprint

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Background: The diagnostic importance of three-dimensional (3D) speckle-tracking strain-imaging echocardiography in patients with acute myocarditis has not yet been assessed. The aim of this study was to test the sensitivity and specificity of 3D-speckle-tracking echocardiography as compared to CMR (cardiovascular magnetic resonance imaging) for the diagnosis of acute myocarditis. Methods and Results: 45 patients that were admitted to the Medical Clinic II of the University Hospital Bonn with clinically suspected myocarditis were enrolled in our study (71% male, mean age: 43.9±16.3 years, peak troponin level: 1.38±3.51 ng/ml). 3D full-volume echocardiographic images were obtained and offline speckle-tracking analysis of regional and global LV deformation was performed. All patients received CMR scans and myocarditis was diagnosed in 29 subjects. The 16 patients, in whom myocarditis was excluded by CMR, served as controls. Regional changes in myocardial texture and tissue edema (diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. The 3D diastolic strain index was not associated with pathological findings in the CMR. However, the 3D global longitudinal strain (GLS) outperformed well-known 2D parameters associated with myocarditis, such as LVEF and LVEDV. Conclusions: This is the first study examining the use of 3D-speckle-tracking echocardiography in patients with acute myocarditis. Global longitudinal strain was significantly associated with and impaired in patients with myocarditis. Therefore, 3D echocardiography could become a useful diagnostic tool in the primary diagnosis of myocarditis.

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Subclinical left ventricular dysfunction and correlation with regional strain analysis in myocarditis with normal ejection fraction. A new diagnostic criterion

Cited by 56 publications

References 23 publications

Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography

Myocarditis successfully diagnosed and controlled with speckle tracking echocardiography

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

3D-speckle-tracking echocardiography correlates with CMR diagnosis of acute myocarditis

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