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Right and left ventricular cardiac magnetic resonance imaging derived peak systolic strain is abnormal in children with myocarditis

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The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Cardiac Magnetic resonance (CMR) derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is a useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis.

Methods

Children with acute myocarditis who underwent CMR between 2016–2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using circle cvi42®. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls.

Results

38 myocarditis and 14 controls met inclusion criteria (mean age 14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls.

Conclusion

CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non-COVID myocarditis.

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Abbreviations

CMR:

Cardiac Magnetic Resonance Imaging

LV:

left ventricle

RV:

right ventricle

COVID-19:

Coronavirus disease

MIS-C:

multisystem inflammatory syndrome in children

ECG:

electrocardiogram

CKMB:

creatine kinase myocardial band

LGE:

late gadolinium enhancement

EF:

ejection fraction

BSA:

body surface area

EDVi:

indexed end-diastolic volume

SD:

standard deviation

ms:

milliseconds

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Children’s Heart Institute, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 425, Houston, TX, 77030, USA

    Elisa Rhee, Julija Dobrila, Harmanpreet Kaur, Mehul D. Patel & Santosh C. Uppu

  2. Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Heart Center, 1111 Marcus Ave, Suite M15, New Hyde Park, NY, 11042, USA

    Elisa Rhee

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  1. Elisa Rhee
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Elisa Rhee, Harmanpreet Kaur and Santosh Uppu. Statistical analysis was performed by Julija Dobrila and Santosh Uppu. The first draft of the manuscript was written by Elisa Rhee and Santosh Uppu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conference Presentation: Abstract was presented at the annual Society for Cardiovascular Magnetic Resonance conference February 2022.

Corresponding author

Correspondence to Santosh C. Uppu.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by The University of Texas Health Science Center at Houston and Memorial Hermann Institutional Review Board (HSC-MS-20-0153, March 9th, 2020) and waived the need for informed consent. All human studies at the University of Texas at Houston Health Science Center and Memorial Hermann hospital have to go through rigorous review by the ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The subjects were deidentified as per our IRB guidelines. Due to the retrospective nature, this study does not require contacting subjects as such a waiver of consent was requested and was approved by the IRB.

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Rhee, E., Dobrila, J., Kaur, H. et al. Right and left ventricular cardiac magnetic resonance imaging derived peak systolic strain is abnormal in children with myocarditis. Int J Cardiovasc Imaging 40, 139–147 (2024). https://doi.org/10.1007/s10554-023-02975-y

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