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Speckle tracking echocardiography in acute myocarditis

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Abstract

To evaluate 2-dimensional speckle tracking echocardiography as a diagnostic and prognostic tool in patients with acute myocarditis. In this retrospective cohort study, 45 patients (age, 39 ± 15 years; 32 male) with suspected acute myocarditis and 83 healthy controls (age, 39 ± 13 years; 27 male) underwent 2-dimensional speckle tracking echocardiography. Main outcome measures were circumferential and longitudinal strain and strain rate as prognostic and diagnostic markers. Patients with myocarditis had lower circumferential strain (−13.3 ± 5.6 % vs. −22.3 ± 4 %), circumferential strain rate (−0.9 ± 0.3 vs. −1.4 ± 0.3 s−1), longitudinal strain (−11.7 ± 4 % vs. −17.7 ± 1.9 %), and longitudinal strain rate (−0.7 ± 0.2 vs. −1.0 ± 0.1 s−1) (all P < .001). For diagnostic purposes, longitudinal strain had the greatest area under the curve, 0.93 (optimal cutoff value, −15.1 %; sensitivity, 78 %; specificity, 93 %). Future events were defined as cardiac death, heart transplant, placement of left ventricular assist device or implantable cardioverter-defibrillator, pulmonary edema–related respiratory failure, cardiogenic shock, and rehospitalization due to cardiac events. For every 1 % decline in longitudinal or circumferential strain, the hazard ratios (95 % CIs) were 1.26 (1.10–1.47) and 1.34 (1.14–1.63), respectively; for every 0.1 s−1 decline in longitudinal or circumferential strain rate, the hazard ratios (95 % CIs) were 1.43 (1.09–1.89) and 1.52 (1.19–2.01), respectively (P < .01). Kaplan–Meier curve and log-rank test showed event-free survival significantly related to these 4 measurements. In acute myocarditis, left ventricular strain and strain rate may be promising diagnostic and prognostic tools, even in patients with preserved left ventricular ejection fraction. Most importantly, this imaging technique had a role in predicting deterioration and overall event-free survival.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

FOV:

Field of view

HR:

Hazard ratio

LGE:

Late gadolinium enhancement

OR:

Odds ratio

SSFP:

Steady-state free precession

TE:

Echo time

TI:

Inversion time

TR:

Repetition time

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Author notes

  1. Ju-Feng Hsiao

    Present address: Cardiovascular Division, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Chang Gung University, Chia-Yi, Taiwan

Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Ju-Feng Hsiao, Yuki Koshino, Crystal R. Bonnichsen, Yang Yu, Fletcher A. Miller Jr., Patricia A. Pellikka, Leslie T. Cooper Jr. & Hector R. Villarraga

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  1. Ju-Feng Hsiao
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  2. Yuki Koshino
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Correspondence to Hector R. Villarraga.

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Hsiao, JF., Koshino, Y., Bonnichsen, C.R. et al. Speckle tracking echocardiography in acute myocarditis. Int J Cardiovasc Imaging 29, 275–284 (2013). https://doi.org/10.1007/s10554-012-0085-6

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  • DOI: https://doi.org/10.1007/s10554-012-0085-6

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