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

2021 ◽  
Author(s):  
Anna Degiovanni ◽  
Maria Concetta Pastore ◽  
Enrico Guido Spinoni ◽  
Marta Focardi ◽  
Matteo Cameli ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Imaging Modality ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Delayed Diagnosis ◽  
Left Ventricular ◽  
Absolute Value ◽  
Study Population ◽  
Laboratory Examinations ◽  
Wbc Count

AbstractCardiac magnetic resonance imaging (CMRI) represents the main imaging modality for diagnosing acute myocarditis. However, its limited availability could entail missing or delayed diagnosis. A reduction of left ventricular global longitudinal strain (LV GLS) by speckle tracking echocardiography (STE) correlates with amount of oedema in acute myocarditis and here may be early detected. Aim was to evaluate the diagnostic and prognostic role of 3-layers LV GLS in patients with acute myocarditis. Out of 122 patients with suspected acute myocarditis, a total of 86 consecutive patients with CMRI-confirmed acute myocarditis admitted in two Italian institutions were retrospectively screened. Exclusion criteria were met in 29 patients because of poor acoustic window or missing data. A total of 57 patients were then included. Clinical characteristics, laboratory examinations, transthoracic echocardiography data and STE parameters were collected early after hospitalization. In the study population, mean age was 38.8 ± 15.6 years, the prevalence of male gender was 90%. On admission, 22 patients (39%) had fever (body temperature > 37.5 °), mean white blood cell (WBC) count was 10.9 ± 1.7/10^3 and overall LV ejection fraction was 50.1% ± 11.2. An epicardial LV GLS < 18% was present in 74% of patients, and a model including at least one of LV GLS < 18% (absolute value), fever and WBC > 10.0/10^3 was able to identify all patients with CMRI-diagnosed acute myocarditis. An epicardial LV GLS < 15.3% (absolute value) at baseline significantly predicted the lack of myocarditis resolution during follow-up (AUC 0.76, 95% CI 0.58–0.93, p = 0.02). A multiparametric model including epicardial LV GLS, fever and elevated WBC count on admission could be useful for early diagnosing an acute myocarditis, especially when CMRI is not promptly available. Baseline epicardial LV GLS may also identify patients with less-likely myocarditis resolution.

scholarly journals Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saikrishna Ananthapadmanabhan ◽  
Giau Vo ◽  
Tuan Nguyen ◽  
Hany Dimitri ◽  
James Otton
Keyword(s):  
Feature Tracking ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Multilayer Strain

Abstract Background Cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) are well-established strain imaging modalities. Multilayer strain measurement permits independent assessment of endocardial and epicardial strain. This novel and layer specific approach to evaluating myocardial deformation parameters may provide greater insight into cardiac contractility when compared to whole-layer strain analysis. The aim of this study is to validate CMR-FT as a tool for multilayer strain analysis by providing a direct comparison between multilayer global longitudinal strain (GLS) values between CMR-FT and STE. Methods We studied 100 patients who had an acute myocardial infarction (AMI), who underwent CMR imaging and echocardiogram at baseline and follow-up (48 ± 13 days). Dedicated tissue tracking software was used to analyse single- and multi-layer GLS values for CMR-FT and STE. Results Correlation coefficients for CMR-FT and STE were 0.685, 0.687, and 0.660 for endocardial, epicardial, and whole-layer GLS respectively (all p < 0.001). Bland Altman analysis showed good inter-modality agreement with minimal bias. The absolute limits of agreement in our study were 6.4, 5.9, and 5.5 for endocardial, whole-layer, and epicardial GLS respectively. Absolute biases were 1.79, 0.80, and 0.98 respectively. Intraclass correlation coefficient (ICC) values showed moderate agreement with values of 0.626, 0.632, and 0.671 respectively (all p < 0.001). Conclusion There is good inter-modality agreement between CMR-FT and STE for whole-layer, endocardial, and epicardial GLS, and although values should not be used interchangeably our study demonstrates that CMR-FT is a viable imaging modality for multilayer strain

scholarly journals Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction

2019 ◽  
Vol 6 (4) ◽  
pp. 81-89
Author(s):  
Gowsini Joseph ◽  
Tomas Zaremba ◽  
Martin Berg Johansen ◽  
Sarah Ekeloef ◽  
Einar Heiberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Longitudinal Strain ◽  
Early Stage ◽  
Global Longitudinal Strain ◽  
Apical Part ◽  
Left Ventricular ◽  
Percent Increase ◽  
Study Population

The aim of this study was to investigate if there was an association between infarct size (IS) measured by cardiac magnetic resonance (CMR) and echocardiographic global longitudinal strain (GLS) in the early stage of acute myocardial infarction in patients with preserved left ventricular ejection fraction (LVEF). Patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were assessed with CMR and transthoracic echocardiogram within 1 week of hospital admission. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 17-segment model covering the entire left ventricular myocardium. GLS was calculated automatically. LVEF was measured by auto-LVEF in EchoPac. IS was measured by late gadolinium enhancement CMR in short-axis views covering the left ventricle. The study population consisted of 49 patients (age 60.4 ± 9.7 years; 92% male). The study population had preserved echocardiographic LVEF with a mean of 45.8 ± 8.7%. For each percent increase of IS, we found an impairment in GLS by 1.59% (95% CI 0.57–2.61), P = 0.02, after adjustment for sex, age and LVEF. No significant association between IS and echocardiographic LVEF was found: −0.25 (95% CI: −0.61 to 0.11), P = 0.51. At the segmental level, the strongest association between IS and longitudinal strain was found in the apical part of the LV: impairment of 1.69% (95% CI: 1.14–2.23), P < 0.001, for each percent increase in IS. In conclusion, GLS was significantly associated with IS in the early stage of acute myocardial infarction in patients with preserved LVEF, and this association was strongest in the apical part of the LV. No association between IS and LVEF was found.

Left Ventricular Function Assessment by Strain Analysis in Patients with Severe Aortic Stenosis with Preserved Ejection Fraction Undergoing Aortic Valve Replacement – A Prospective Longitudinal Study at a Tertiary Health Care Centre of South India

2021 ◽  
Vol 8 (27) ◽  
pp. 2405-2411
Author(s):  
Syed Waleem Pasha ◽  
Narasimha D. Pai ◽  
Padmanabha Kamath ◽  
Ramanatha L. Kamath ◽  
Francis N.P. Monteiro
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Strain Rate ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Study Population

BACKGROUND Aortic stenosis (AS) is the most common, single, native valvular heart disease in adult population. The purpose of this study was to detect abnormalities in global longitudinal strain (GLS) and strain rate using 2D - STI in patients with severe AS and preserved left ventricular ejection fraction (LVEF). The effect of aortic valve replacement (AVR) on changes in strain parameters 30 days after surgery was also analysed. METHODS A total number of 60 patients aged more than 18 years with aortic valve disease scheduled for surgical aortic valve replacement admitted in Department of Cardiology, KMC hospital Mangalore, were included over a period of 18 months from January 2017 to June 2018. RESULTS A total of 60 patients with severe AS, defined by an aortic valve area of < 1 cm², mean transaortic pressure gradient ( P) of > 40 mmHg and maximum aortic velocity (Vmax) of > 4 m/sec were studied. Mean age of the study population was 63.5 years. 60 % of the population were males and 40 % being females. Most common risk factor present in the study population was diabetes mellitus (DM). 83% of the patients in the study population had at least one symptom. Most common symptom with which the patients presented was exertional dyspnoea. All patients had normal left ventricle (LV) cavity dimensions and LVEF prior to surgery with diastolic dysfunction being present in all patients. The LV ejection fraction is not significantly altered. The aortic valve area calculated by continuity equation has significantly increased post AVR with a significant reduction in transaortic peak and means pressure gradients. Mean global longitudinal strain (GLS) improved from -15.1 % to - 16.9 % (P < 0.001) and longitudinal strain rate improved from -0.8 to -0.9/s (P < 0.001). CONCLUSIONS Global longitudinal strain and strain rate can be adequately measured by 2D speckle-tracking imaging and can be used to detect subtle changes of myocardial function in patients with severe AS with preserved LVEF. KEYWORDS Aortic Stenosis, Exertional Dyspnoea, Global Longitudinal Strain, Transaortic Pressure Gradient, Ventricular Hypertrophy

scholarly journals P1318 Clinical utility of global longitudinal strain in acute myocarditis: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Lai Chin Kon ◽  
O Mcconnell ◽  
I Andrade ◽  
A Simpson ◽  
M Luckie
Keyword(s):  
Ejection Fraction ◽  
Risk Stratification ◽  
Cardiac Mri ◽  
Strong Correlation ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Myocardial Oedema

Abstract The role of conventional 2D echocardiography in the setting of acute myocarditis is limited as often it reveals no significant changes in global systolic function. Published studies have demonstrated the usefulness of myocardial deformation imaging in acute myocarditis with global longitudinal strain (GLS) being more sensitive in the recognition of myocardial dysfunction even in preserved systolic function and its strong correlation to the amount of myocardial oedema found on cardiac MRI. It also has the advantage of being more readily available, requiring a shorter interpretation time and is significantly cheaper as compared to cardiac MRI. GLS has also been shown to play a role in risk stratification with a lower GLS being associated with a higher rate of major adverse cardiac events (MACE) among all myocarditis cases independent of LV ejection fraction. We describe a case where there was strong correlation between GLS and myocardial oedema on CMR T1 weighted imaging. A 26 year old with no relevant past medical history presented to hospital complaining of pleuritic sounding chest pain. ECG showed ST segment changes suggestive of pericarditis. White blood cell count and troponin levels were elevated. Echocardiography performed on the same day showed apical akinesia and reduced longitudinal LV function. Global longitudinal strain was an average of -8% and was notably reduced in the apical, inferior, posterior and lateral regions. The overall left ventricular function was normal (55% by bi-plane Simpson"s method). Cardiac MRI showed normal LV size and function with myocardial oedema in the mid inferolateral, apical inferior and apical anterior segments. These findings were consistent with acute myocarditis affecting the involved segments. Our case demonstrates that the global longitudinal strain reduction correlated very similarly to the pattern of myocardial oedema in the affected segments and is consistent with similar findings from published studies. GLS by 2D speckled imaging may therefore play an important role in the assessment of acute myocarditis especially in patients with preserved ejection fraction and may help in risk stratification. Abstract P1318 Figure. combined GLS CMR

scholarly journals Accuracy of an integrated evaluation including clinical presentation, laboratory data and global longitudinal strain by echocardiography for diagnosing acute myocarditis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Degiovanni ◽  
MC Pastore ◽  
EG Spinoni ◽  
M Focardi ◽  
M Cameli ◽  
...  
Keyword(s):  
Body Temperature ◽  
Cardiac Mri ◽  
Early Phase ◽  
Longitudinal Strain ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Laboratory Data ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Current Evidence

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Cardiac magnetic resonance imaging (MRI) represents the gold standard for the diagnosis of acute myocarditis. However, several institutions are not able to perform such imaging test, especially in the early phase of the disease, with possible missing or delaying in diagnosis. On the other hand, the penetration of the trans-thoracic echocardiographic (TTE) assessment of global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is rapidly growing. An impairment in GLS may occur in the early phase of acute myocarditis, with the degree of such impairment being related to the amount of oedema. Few studies have been published on the role of STE in the diagnosis of acute myocarditis and current evidence on the topic is limited. We present here a multicentre, retrospective study on the diagnostic accuracy of a non-invasive model including GLS for acute myocarditis. PURPOSE Aim of the study was the evaluation of the accuracy of 3-layer left ventricular (LV) GLS data (epicardial, midwall and endocardial) coupled with clinical and laboratory assessment for the diagnosis of acute myocarditis, using cardiac MRI as reference diagnostic tool. METHODS A total of 70 patients with clinical suspect of acute myocarditis were identified. Clinical parameters, results of laboratory tests and data from both TTE and STE on admission were recorded. Cardiac MRI was performed in all patients. GLS assessment was reported as absolute value. A total of 13 patients were excluded because of poor acoustic window, unconfirmed diagnosis or missing data. RESULTS 57 patients with MRI-confirmed acute myocarditis were included in the final analysis (age 38.8 ± 15.6 years, 49 males). Twenty-one patients (37.5%) had fever on admission. Mean white blood cell (WBC) count was 10.92/10^3 ± 1.7 and C-reactive protein levels were 4.9 ± 5.2 mg/dL. At TTE, a mild reduction of LV systolic function was overall observed (LV ejection fraction 50.1% ±11.2), without impairment of the diastolic function (E/A Ratio 1.31 ± 0.55, E/e’ average ratio 7.59 ± 3.4). Mean epicardial GLS of the LV was 14.5 ± 4.3%, midwall GLS was 16.5 ± 4.7% and endocardial GLS 18.6 ± 5%. The best localization agreement between regional strain decrease and late gadolinium enhancement at cardiac MRI was found for an epicardial GLS &lt;18% (43 patients, 77%). The integration of STE data (epicardial GLS &lt;18%), clinical signs (body temperature &gt;37.5°) and laboratory findings (WBC &gt;10/10^3) was able to identify all patients (100%) with MRI-diagnosed acute myocarditis (Figure 1). CONCLUSION STE of the LV, especially for epicardial GLS, presents a high agreement with cardiac MRI to detect acute myocarditis. The integration of GLS assessment, body temperature and WBC on admission is highly sensitive for an early diagnosis of acute myocarditis. This model could be more extensively tested in those settings where cardiac MRI is not immediately available. Abstract Figure 1

scholarly journals 100 Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Aldostefano Porcari ◽  
Marco Merlo ◽  
Chiara Baggio ◽  
Giulia Gagno ◽  
Marco Cittar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Longitudinal Strain ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Outcome Analysis ◽  
Haemodynamic Instability ◽  
Adverse Cardiovascular Event ◽  
Prognostic Stratification ◽  
Normal Lvef

Abstract Aims Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular (LV) ejection fraction (EF) relies mostly on late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) imaging. In this specific AM population, LV peak global longitudinal strain (LV-GLS) measured by feature tracking (FT) analysis might provide further prognostic information. Methods and results Data of patients undergoing CMR for clinically suspected AM in seven European Centres, between January 2013 and August 2020, were retrospectively analysed. Those patients fulfilling CMR Lake Louise Criteria (LLC) for the diagnosis of AM and presenting with normal LVEF (≥50%) were included. Patients presenting with heart failure (HF) or significant arrhythmic events, LVEF &lt;50% or haemodynamic instability were excluded. CMR-LGE extent (localized vs. diffuse), localization (subepicardial vs. mid-wall), and distribution (anteroseptal vs. inferolateral) were visually assessed. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including a composite of cardiac death, development of heart failure, life-threatening arrhythmias, or development of LVEF &lt;50%. In patients experiencing more than one event, the first one was considered for the outcome analysis. Of 389 patients with clinically suspected AM, 256 (66%) had confirmed AM with LVEF ≥50% and were included. Median age was 36 years, 71% were males, median LVEF was 60%, and median LV-GLS −17.3%. CMR was performed at a median time of 4 (IQR: 2–12) days from hospital admission. At a median follow-up of 27 months, 24 (9%) patients experienced at least one ACE with development of LVEF &lt;50% accounting for 17 [71%]. Compared to the others, patients experiencing ACEs had lower median LV-GLS values at baseline (−13.9% vs. −17.5%, P = 0.001). At Kaplan–Meier analysis, impaired LV-GLS (both considered as &gt;-20% or quartiles), diffuse and mid-wall LGE were associated with a significantly higher rate of ACEs. LV-GLS remained independently associated with ACEs after adjustment for diffuse or mid-wall LGE as covariate at bivariable analysis. Conclusions In AM with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE, improving risk stratification and providing a rationale for further studies of therapy in this cohort. 100 Figure

scholarly journals Patients with acute myocarditis and preserved systolic left ventricular function: comparison of global and regional longitudinal strain imaging by echocardiography with quantification of late gadolinium enhancement by CMR

2021 ◽  
Author(s):  
Christine Meindl ◽  
Michael Paulus ◽  
Florian Poschenrieder ◽  
Florian Zeman ◽  
Lars S. Maier ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Longitudinal Strain ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Abstract Background Conventional transthoracic echocardiography (TTE) does often not accurately reveal pathologies in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEEF). Therefore, we investigated the diagnostic value of two-dimensional (2D) speckle tracking echocardiography compared to late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis and normal global LVEF. Methods and results 31 patients (group 1) with the diagnosis of acute myocarditis confirmed by CMR according to the Lake Louise criteria and 20 healthy controls (group 2) were analyzed including global longitudinal strain (GLS) and regional longitudinal strain (RLS) derived by the bull’s eye plot. Although preserved LVEF was present in both groups, GLS was significantly lower in patients with acute myocarditis (group 1: GLS − 19.1 ± 1.8% vs. group 2: GLS − 22.1 ± 1.7%, p < 0.001). Compared to controls, lower RLS values were detected predominantly in the lateral, inferolateral, and inferior segments in patients with acute myocarditis. Additionally RLS values were significantly lower in segments without LGE. Conclusion In patients with acute myocarditis and preserved LVEF, a significant reduction of GLS compared to healthy subjects was detected. Further RLS adds important information to the localization and extent of myocardial injury. Graphic abstract

scholarly journals Normalization of global longitudinal strain after a 30-seconds exercise bout in elite athletes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S M Verwijs ◽  
H A C M De Bruin-Bon ◽  
J C Van Hattum ◽  
J L Spies ◽  
R N Planken ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Elite Athletes ◽  
Imaging Modality ◽  
Global Longitudinal Strain ◽  
Mechanical Strain ◽  
Exercise Bout ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Physiological Adaptation ◽  
Post Exercise

Abstract Background/Introduction Transthoracic echocardiography (TTE) is often the first diagnostic imaging modality of choice in athlete care to differentiate between physiological adaptation to sports and pathology. Mechanical strain as outcome measure, i.e. left ventricular (LV) global longitudinal strain (GLS), has been suggested as a tool to detect early signs of myocardial diseases in athletes. However, low or very low rates of myocardial deformation can also be associated with cardiac adaptation to sports. We hypothesize that observing decreased cardiac deformation in elite athletes may be a sign of an outspoken relaxed cardiac state, rather than pathology. Therefore, we investigated whether a short exercise bout can normalize strain values in elite athletes with abnormal resting GLS. Methods We prospectively enrolled elite athletes who participated in the ELITE (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise) cohort. In short, ELITE is a prospective athlete cohort, which collects medical history, ECG, TTE and cardiac magnetic resonance (CMR) data in elite athletes (Olympic/Paralympic level or comparable). For this analysis, we analysed TTEs of asymptomatic athletes without cardiovascular disease and with a structurally normal heart on CMR. TTE (Vivid, GE) was performed in each athlete according to guidelines at rest. After a short exercise bout, consisting of 20 squats, additional measurements were performed when heart-rate (HR) was comparable to HR during pre-exercise measurements. TTE data was assessed using EchoPAC (GE). Paired t-tests were calculated for functional parameters; boxplots for pre- and post-exercise measurements; and GLS delta (pre- to post-exercise) for each athlete was calculated were plotted; using R. GLS ≥−16% was considered decreased and −16% ≥ GLS &gt;−18% borderline. Results Our population comprised 51 athletes (35% women), with a mean age (±SD) of 26.4±5.2 years, and mean BSA of 2±0.3m2. Athletic disciplines consisted of road cycling (n=25), hockey (n=7), swimming (n=5), and 7 miscellaneous sports (n=14). We observed an increase of myocardial deformation after a short bout of exercise: mean GLS delta of 2.6±2% (pre- vs post-exercise GLS: −18.2±2.1% vs −20.8±1.9%; P≤0.001; Figure, A). Furthermore, mean LV stroke volumes were 94±19ml vs 103±23ml (P=0.020), ejection fractions (EF) 57±4% vs 60±4% (P≤0.001), and HR 55±10bpm vs 54±13bpm (P=0.8). Finally, we found a decreased strain in 8 athletes (16%), in 7 of which increased to normal values. Mean delta GLS was 4.5±2.2 (pre- vs post-exercise GLS: −14.9±1.1% vs −19.4±2.7%, P=0.002, Figure, B). The athlete who did not show an increase to normal GLS levels had a decreased LV EF (42%), but showed no other signs of cardiac pathology (MRI, biomarkers, complaints). Conclusion In athletes with abnormal GLS at rest, performing a short exercise bout may provide a pragmatic method to separate decreased GLS due to true pathology from sports adaptation. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences

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