Abstract 9020: Utilizing Speckle Tracking Echocardiography to Analyze Strain Patterns in Pediatric Patients with Suspected Myocarditis
Background: Myocarditis is a rare disease involving inflammation of the myocardium which causes significant morbidity and mortality in children. Currently, endomyocardial biopsy is the only definitive way to diagnose myocarditis but techniques such as echocardiography and cardiac MRI can be utilized to aid in diagnosis. New advances such as speckle tracking echocardiography (STE) can analyze myocardial strain patterns which are a more sensitive measure of ventricular function. The primary aim of this study is to determine if 2D strain imaging via STE in children with suspected myocarditis correlates with other methodologies currently used in making the diagnosis.
Methods: A retrospective review was conducted to identify all patients with suspected myocarditis from 2004-2010.Standard 2D echocardiograms were analyzed off-line using the Syngo Velocity Vector imaging software to determine global strain and strain rate in the longitudinal and circumferential views.
Results: A total of 66 patients with suspected myocarditis were compared to 29 age matched controls. Of the 66 study patients, 48% (32/66) underwent endomyocardial biopsy and/or MRI. Global longitudinal and circumferential strain and strain rates were lower in the suspected myocarditis group compared to controls (P <0.005). Patients who underwent further workup with either biopsy and/or MRI had significantly decreased circumferential strain rate (P <0.03) and especially decreased longitudinal strain rate (P <0.003) when compared to those who did not have further diagnostic testing with biopsy or MRI. Furthermore, all patients with biopsy or MRI proven myocarditis had decreased longitudinal and circumferential global strain and strain rates as compared to controls (P <0.0008).
Conclusions:: STE can be a useful diagnostic tool in identifying patients with suspected myocarditis. In our study, all global strain and strain rate values were significantly decreased in patients with proven myocarditis as compared to controls. Specifically, longitudinal strain rate may be a more sensitive diagnostic tool to select patients who merit further testing. Further work is needed to determine if STE correlates with segmental abnormalities on MRI in children with suspected myocarditis.
- © 2011 by American Heart Association, Inc.