Abstract 20570: Left Ventricular Deformation by 2-D Speckle Tracking Echocardiogram for the Diagnosis of Acute Myocarditis With Preserved LV Ejection Fraction
Background: Currently, the diagnosis of acute myocarditis in patients with normal ejection fraction (EF) is challenging. Strain (S) and strain rate (SR) imaging, measured by 2-D speckle tracking echocardiogram (2D-STE) permit assessment of myocardial mechanics. Our aim was to evaluate S and SR in patients with acute myocarditis and preserved LV EF.
Methods & Results: We enrolled 19 patients (15 males, age 37 ± 15 yrs) with suspected acute myocarditis, defined as symptoms and evidence of myocardial damage by biomarkers or cardiac structural defect by an imaging study in the absence of active coronary ischemia and EF ≥ 50% by 2-D echocardiogram (echo). Healthy individuals with a normal 2-D echo served as controls. Exclusion criteria: previous heart surgery, significant valvular disease or arrhythmias. Standard 2-D echo (short-axis and 3 apical views) at presentation were analyzed off-line for global peak longitudinal and circumferential S and SR (LS, LSR, CS and CSR) via Syngo Velocity Vector image software (Siemens Medical Solutions, Malvern, PA). In univariate analyses, significant differences between the two groups included septal thickness (10 ± 1 vs. 9 ± 1 mm), LV end-systolic dimension (LVESD) (34 ± 5 vs. 30 ± 3 mm), and EF (59 ± 6 vs. 64 ± 4%) (p < 0.05). LS (−14.5 ± 3.1 vs. −17.7 ± 1.9%), LSR (−0.8 ± 0.16 vs. −0.99 ± 0.12 S−1), CS (−17.4 ± 4.9 vs. −22.3 ± 3.9%) and CSR (−1.07 ± 0.31 vs. −1.37 ± 0.27 S−1) were significantly lower in the myocarditis group (p < 0.05). By receiver operating characteristic analysis, LS had the greatest area under the curve (AUC: 0.83, optimal cut-off value −16.9%, 84% sensitivity, 68% specificity). Multiple logistic regression analysis, adjusting for gender, septal thickness, LVESD, LVEF, showed that these LV deformation indices were still significant (p < 0.05). Odds ratios (95% CI) were as follows: LS: 1.77 (1.23–2.92), CS: 1.27 (1.06–1.56); for LSR and CSR (per 0.1 S−1) was 2.83 (1.49–6.7) and 1.44 (1.1–2.01).
Conclusion: Among patients with preserved EF, LV deformation derived from 2D-STE appeared promising to identify patients with acute myocarditis.
- © 2010 by American Heart Association, Inc.