Abstract
Background
Myocarditis is an inflammatory disease of the myocardium predominantly caused by infection with subsequent immunological response. Cardiac magnetic resonance (CMR) is the currently best imaging modality to confirm a suspected diagnosis of myocarditis. Conventional echocardiography can detect regional or global wall motion abnormalities but it could also be negative. Speckle tracking echocardiography can help to identify subtle systolic dysfunction, in patients with myocardits and apparently negative echocardiogram.
Purpose
the aim of this study was to identify cardiac imaging parameters predictive of cardiovascular events in patients with acute myocarditis.
Methods
a prospective study was carried out using 76 patients with acute myocarditis. Cardiological evaluation including echocardiogram and CMR with quantitative analysis of edema and delayed enhancement (DE) was performed in all patients at the hospital admission.
In 43 patients we assessed multilayer 2D speckle tracking analysis measuring GLS at three levels (mid-wall layer, endocardial and epicardial) and mechanical dispersion (MD). We assessed cardiovascular events during hospitalization in all patients (arrhythmias, heart failure, cardiogenic shock, syncope).
Results
we found significant higher value of DE mass in patients with cardiovascular events compared to patients without cardiovascular events (20,23 ± 11,47gr vs 11,58 ± 9,54gr; p = 0,021). GLS and multilayer strain at each level was significantly lower in patients with events than in patients without events (GLS epicardial -16,29 ± 1,76% vs -14,54 ± 2,19%; p = 0,013; GLS mid-wall -18,22 ± 1,94% vs -16,27 ± 2,48%; p = 0,013; GLS endocardial -19,83 ± 1,91% vs -17,81 ± 2,65%; p = 0,011).
MD was significantly higher in patients with cardiovascular events (48.50 ± 15.79 ms vs 34.12 ± 6.22ms; p < 0,001). Logistic regression analysis showed that DE is a good predictor of events (ROCarea 0,81-OddsRatio 1,09). Also GLS seems to be predictive of events (GLS epicardial: ROC area 0,72-OddsRatio 1,57; GLS mid wall: ROC area 0,73-OddsRatio 1,52; GLS endocardial: ROC area 0,72-OddsRatio 1,48).
With segmental analysis, inferior and lateral walls seemed to be more predictive of events. Segment 9 had a good predictability in all layers (epicardial: ROCarea 0,8-OddsRatio 1,69; mid wall: ROCarea 0,83- OddsRatio 1,77; endocardial: ROC area 0,82-OddsRatio 1,69).
MD was a slight predictor of events with ROC area < 0,7.
Conclusions
Speckle tracking echocardiography could be used in addiction to cardiac magnetic resonance to get more information about prognosis and events risk stratification in patients with acute myocarditis.
1232 Acute myocarditis: prognostic role of speckle tracking echocardiography and cardiac magnetic resonance
