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.