Left and right ventricular strain in the course of acute myocarditis: a cardiovascular magnetic resonance study

Widmung

Diese Arbeit ist Herrn Professor Hans H. Schild gewidmet, bei dem wir uns herzlich für die langjährige und stete Unterstützung in allen klinischen und wissenschaftlichen Belangen bedanken möchten.

Abstract

Purpose To investigate the degree of impairment in left (LV) and right ventricular (RV) myocardial strain parameters over the course of acute myocarditis and to evaluate its value for the prediction of functional recovery upon follow-up.

Materials and Methods 69 patients with acute myocarditis underwent cardiac magnetic resonance imaging during the acute stage (baseline) and after a mean 92.5 ± 50.4 days follow-up. Standard “Lake Louise” criteria (T2 signal intensity ratio, early gadolinium enhancement ratio and late gadolinium enhancement) and feature tracking derived LV and RV strain parameters were assessed. Logistic regression analysis was used to find predictors of functional recovery upon follow-up.

Results All inflammatory parameters showed a considerable decrease over the course of the disease (P < 0.001 for all parameters). LV and RV function significantly improved on follow-up CMR (LV ejection fraction: 53.5 ± 12.7 % vs. 61.3 ± 9.5 %; P < 0.001, RV ejection fraction: 54.1 ± 10.0 % vs. 59.4 ± 6.3 %; P < 0.001). LV and RV myocardial strain (longitudinal, circumferential and radial strain) significantly improved from baseline to follow-up (P < 0.05 for all parameters). On multivariate analysis, LV global peak systolic longitudinal strain (OR: 0.303; P = 0.007) was the only independent predictor of functional recovery upon follow-up. 

Conclusion Alterations in LV and RV functional strain parameters occur frequently during the acute stage of myocarditis. During the course of the disease, a significant improvement in LV and RV strain parameters can be observed. It further appears that initial LV longitudinal strain may serve as a new parameter for the prediction of functional recovery upon follow-up.

Key Points 

• Myocardial strain parameters significantly improve during the course of acute myocarditis.

• RV dysfunction can frequently be observed during the acute stage of myocarditis.

• LV longitudinal strain can independently predict functional recovery upon follow-up.

Citation Format

• Luetkens JA, Petry P, Kuetting D et al. Left and right ventricular strain in the course of acute myocarditis: a cardiovascular magnetic resonance study. Fortschr Röntgenstr 2018; 190: 722 – 732

Zusammenfassung

Ziel Gegenstand der Studie war die Untersuchung im Rahmen einer Verlaufsbeobachtung der akuten Myokarditis dahingehend, ob Beeinträchtigungen in links- (LV) und rechtsventrikulären (RV) Strainparametern vorhanden sind. Darüber hinaus war beabsichtigt, die Strainparameter hinsichtlich ihrer Voraussagekraft für eine Funktionsnormalisierung in der Nachuntersuchung zu evaluieren.

Material und Methoden Es wurden 69 Patienten mit Myokarditis in der Akutphase (Baseline) und nach durchschnittlich 92,5 ± 50,4 Tagen mittels kardialer Magnetresonanztomografie untersucht. Die „Lake Louise“ Kriterien (T2 Signalintensitätsratio, „early gadolinium enhancement ratio“ und „late gadolinium enhancement“) und LV und RV myokardiale Strainparameter wurden ausgewertet. Eine logistische Regressionsanalyse wurde durchgeführt, um Prädiktoren für eine Funktionsnormalisierung in der Nachuntersuchung zu finden.

Ergebnisse Alle inflammatorischen Parameter verbesserten sich deutlich in der Nachuntersuchung (P < 0,001 für alle Parameter). Entsprechend war auch die LV und RV Funktion in der Nachuntersuchung signifikant verbessert (LV Ejektionsfraktion: 53,5 ± 12,7 % vs. 61,3 ± 9,5 %; P < 0,001, RV Ejektionsfraktion: 54,1 ± 10,0 % vs. 59,4 ± 6,3 %; P < 0,001). LV und RV Strainparameter (longitudinaler, zirkumferentieller und radialer Strain) verbesserten sich ebenfalls in der Nachuntersuchung signifikant im Vergleich zur initialen Untersuchung (P < 0,05 für alle Parameter). Der initiale LV globale systolische longitudinale Strain war der einzige Parameter in der multivariaten Regressionsanalyse, der unabhängig eine Funktionsverbesserung in der Nachuntersuchung voraussagen konnte (OR: 0,303; P = 0,007).

Schlussfolgerung Pathologische Veränderungen in LV und RV Strainparameter lassen sich in der Akutphase der Myokarditis häufig beobachten. Im Laufe der Erkrankung erholen sich diese Funktionseinschränkungen häufig wieder. Die zusätzliche Bestimmung des initialen LV globalen systolischen longitudinalen Strains könnte zudem hilfreich sein, eine Funktionsnormalisierung im Laufe der Erkrankung vorauszusagen.

Kernaussagen 

• Beeinträchtigungen des myokardialen Strains bei Myokarditis erholen sich meist im Verlauf.

• Eine RV Dysfunktion kann in der Akutphase häufig beobachtet werden.

• Der LV longitudinale Strain kann eine Funktionsnormalisierung in der Verlaufsuntersuchung voraussagen.

Key words

follow-up - myocarditis - cardiac magnetic resonance - myocardial strain analysis

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