Multimodality imaging approach in the diagnosis of chronic myocarditis with preserved left ventricular ejection fraction (MCpEF): The role of 2D speckle-tracking echocardiography

Mario Kasner, Aleksandar Aleksandrov, Felicitas Escher, Nidal Al-Saadi, Markus Makowski, Frank Spillmann, Martin Genger, Heinz Peter Schultheiss, Uwe Kühl, Burkert Pieske, Daniel A. Morris, Michel Noutsias, Carsten Tschöpe

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background Up to one third of patients with chronic myocarditis (MC) have preserved left ventricular (LV) ejection fraction (MCpEF). The purpose of this study was to evaluate the role of adding 2D speckle-tracking echocardiography (STE) to cardiac magnetic resonance imaging (cMRI) in the diagnosis of patients with MCpEF. Methods and results We analyzed 67 patients with suspected MCpEF who underwent endomyocardial biopsy (EMB). Thirty-two patients with confirmed chronic myocardial inflammation by EMB served as study group (MCpEF) and the remaining patients (n = 35) served as control group. In all patients, 2D STE and cMRI were performed within 48 h before EMB. Patients with MCpEF had significantly lower LV global longitudinal systolic strain (GLS) than controls (GLS: − 17.01 ± 2.42% vs. − 19.39 ± 3.81%, p < 0.001; respectively). In line, an abnormal GLS had adequate diagnostic performance to detect MCpEF (sensitivity, specificity, and accuracy of 82%, 70%, and 76%, respectively), which was superior to cMRI based on the Lake-Louise criteria (sensitivity, specificity, and accuracy 54%, 71%, and 67%, respectively). In addition, adding GLS to the Lake-Louise criteria improved significantly the diagnostic performance of cMRI to detect MCpEF (sensitivity, specificity, and accuracy 96%, 55%, and 75%, respectively). Conclusion The findings of this study suggest that GLS using 2D STE could play an important role in the diagnostic evaluation of patients with suspected chronic myocarditis with preserved LV ejection fraction (MCpEF).

Original languageEnglish
Pages (from-to)374-378
Number of pages5
JournalInternational Journal of Cardiology
Volume243
DOIs
StatePublished - 15 Sep 2017
Externally publishedYes

Keywords

  • Cardiac magnetic resonance imaging
  • Endomyocardial biopsy
  • HFpEF
  • MCpEF
  • Myocarditis
  • Speckle tracking echocardiography

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