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Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis
Abstract
AIMS: The clinical diagnosis of acute myocarditis is based on symptoms, electrocardiography, elevated myocardial necrosis biomarkers, and echocardiography. Often, conventional echocardiography reveals no obvious changes in global cardiac function and therefore has limited diagnostic value. Myocardial deformation imaging by echocardiography is an evolving method used to characterize quantitatively longitudinal systolic function, which may be affected in acute myocarditis. The aim of our study was to assess the utility of echocardiographic deformation imaging of the left ventricle in patients with diagnosed acute myocarditis in whom cardiovascular magnetic resonance (CMR) evaluation was performed. METHODS AND RESULTS: We included 28 consecutive patients (mean age 32 ± 13 years) with CMR-verified diagnosis of acute myocarditis according to the Lake Louise criteria. Cardiac function was evaluated by a comprehensive assessment of left ventricular (LV) function, including 2D speckle-tracking echocardiography. We found no significant correlation between the peak values of cardiac enzymes and the amount of myocardial oedema assessed by CMR (troponin: r= 0.3; P = 0.05 and CK-MB: r = 0.1; P = 0.3). We found a larger amount of myocardial oedema in the basal part of the left ventricle [American Heart Association (AHA) segments 1-6] in inferolateral and inferior segments, compared with the anterior, anterolateral, anteroseptal, and inferoseptal segments. In the mid LV segments (AHA segments 7-12), this was more pronounced in the anterior, anterolateral, and inferolateral segments. Among conventional echocardiographic parameters, LV function was not found to correlate with the amount of myocardial oedema of the left ventricle. In contrast, we found the wall motion score index to be significantly correlated with the amount of myocardial oedema, but this correlation was only present in patients with an extensive amount of oedema (>11% of the total left ventricle). Global longitudinal systolic myocardial strain correlated significantly with the amount of oedema (r = 0.65; P < 0.001). We found that both the epicardial longitudinal and the endocardial longitudinal systolic strains were significantly correlated with oedema (r = 0.55; P = 0.003 and r = 0.54; P < 0.001). CONCLUSION: In patients with acute myocarditis, 2D speckle-tracking echocardiography was a useful tool in the diagnostic process of acute myocarditis. Global longitudinal strain adds important information that can support clinical and conventional echocardiographic evaluation, especially in patients with preserved LV ejection fraction in relation to the diagnosis and degree of myocardial dysfunction.
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“In a small cohort study involving 28 patients with CMR-confirmed myocarditis, global longitudinal myocardial strain, both epicardial and endocardial, was found to correlate with edema detected on CMR.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [237]
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The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease
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Diagnosis and Treatment of Acute Myocarditis: A Review
Ammirati, E., & Moslehi, J. J. (2023) · JAMA · doi:10.1001/jama.2023.3371 · Cited by 379
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Pryds, K., Larsen, A. H., Hansen, M. S., Grøndal, A. Y. K., Tougaard, R. S., Hansson, N. H., Clemmensen, T. S., Løgstrup, B. B., Wiggers, H., Kim, W. Y., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-47775-4 · Cited by 75
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Metadata
- Authors
- Løgstrup, B. B., Nielsen, J. M., Kim, W. Y., & Poulsen, S. H.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Løgstrup, B.B.
- Venue
- European Heart Journal – Cardiovascular Imaging
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-20
- Volume
- 17
- Issue
- 9
- Pages
- 1018-1026
- ISSN
- 2047-2404 (ISSN-L)
- 2047-2412
- OpenAlex
- W2285375100
- Cited by
- 105
- References
- 31
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 13 · 2022: 19 · 2021: 20 · 2020: 14 · 2019: 10 · 2018: 3 · 2017: 5 · 2016: 3
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal - Cardiovascular Imaging (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- acute myocarditis, myocardial edema, speckle tracking echocardiography, myocardial deformation, left ventricular systolic function, myocardial strain, wall motion score index, cardiovascular magnetic resonance, troponin, CK-MB, Lake Louise criteria, myocardial necrosis biomarkers
- MeSH terms
- Acute Disease, Adult, Echocardiography, Edema, Cardiac, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Myocarditis, Prospective Studies, Radiographic Image Enhancement, Severity of Illness Index, Cohort Studies, Observer Variation, Confidence Intervals, Logistic Models, Statistics, Nonparametric, Magnetic Resonance Imaging, Cine, Gadolinium DTPA, Young Adult
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