Speckle Tracking Imaging in Myocarditis

Marina Leitman Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel Aviv University, Zerifin, Israel Zvi Vered Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel Aviv University, Zerifin, Israel Vladimir Tyomkin Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel Boris Macogon Department of Radiology, Assaf Harofeh Medical Center, Zerifin, Israel Gil Moravsky Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel Aviv University, Zerifin, Israel Eli Peleg Department of Cardiology, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel Aviv University, Zerifin, Israel Laurian Copel Department of Radiology, Assaf Harofeh Medical Center, Zerifin, Israel Sackler School of Medicine, Tel Aviv University, Zerifin, Israel

Purpose. Accurate diagnosis of acute myocarditis is important for the prognosis and risk stratification of these patients. Cardiac magnetic resonance [CMR] has become a major modality for diagnosis of myocarditis, but not widely available. In this study, we tried to evaluate regional and global longitudinal strain by speckle tracking echocardiography in patients with acute inflammatory myocardial diseases in correlation with CMR.

Methods. Patients with suspected acute myocarditis were recruited prospectively. Clinical diagnosis was established based on clinical, electrocardiographic, laboratory and conventional echocardiographic data. All patients underwent CMR and repeat echocardiographic examination within 24 hours of CMR. Echocardiographic examinations were analyzed offline with speckle tracking imaging software.

Results. 32 patients with acute perimyocarditis and myopericarditis were included. Mean age was 29±8, 30 males. All patients presented with chest pain and an abnormal electrocardiogram, in 28 ST elevation was found. Troponin was elevated in 30 and was 0.7±0.5 ng/ml. Creatine kinase was 487±319U. LVEF was 56±5%. Wall motion abnormalities were present in postero-lateral (53%), and inferior wall (21%). Delayed enhancement on CMR was found in 29 patients. Echocardiographic EF based on speckle tracking imaging correlated with CMR calculated EF. There was a positive correlation between the amplitude of regional strain and delayed enhancement, r=0.52. Sensitivity and specificity of regional strain for prediction of delayed enhancement was 85% and 73% respectively.

Conclusions. Speckle tracking imaging can help in the diagnosis of acute myocarditis when CMR is not readily available.

Presentation

Marina Leitman

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