ASSESSMENT OF LEFT VENTRICULAR MECHANICS IN ACUTE AND CHRONIC PHASES OF MYOCARDITIS: A STUDY WITH CARDIAC MAGNETIC RESONANCE IMAGING AND 2D STRAIN ECHOCARDIOGRAPHY

MYOCARDIAL DEFORMATION AFTER ACUTE MYOCARDITIS WITH INFARCT-LIKE PRESENTATION. A 2-D STRAIN FOLLOW-UP STUDY Abstract BACKGROUND: The aim of present study was to assess left ventricular (LV) myocardial deformation and over-time changes in patients with acute myocarditis (AM) with infarct-like presentation. METHODS : 35 male patients with diagnosis of AM with preserved systolic function on the basis of cardiac magnetic resonance imaging (MRI) were prospectively enrolled. On admission, echocardiography with measurement of global longitudinal (LS), circumferential (CS) and radial (RS) strains, was performed both at endocardial (ENDO) and epicardial (EPI) levels. Findings were compared to 25 control subjects. RESULTS : Twenty-six patients were also monitored over a 22-month follow-up (FU group). On admission global ENDO-LS was poorer in AM (-19.2±3.1) than in controls (-24.0±1.05) (p<0.0001), whereas EPI-LS was not different (-20.6±3.4 vs -19.7±6, respectively, p=NS). A functional increase in both ENDO-LS (-20.8±5.4, p=NS) and EPI-LS (-22.6±4.6, p=0.02) was found in FU versus AM patients. EPI-CS also improved from -8.9±2.2 to -10.7±2.3 (p<0.0001), as well as ENDO-CS (from -21.4±4.2 to -23.3±4.9, p=0.001), whereas RS remained unchanged. Strain values were chiefly impaired in segments showing late gadolinium enhancement on admission cardiac MRI. CONCLUSIONS: The present study demonstrates a steady ENDO-LS impairment in infarct-like AM during a two-year follow-up period, despite preserved LV ejection fraction. This is more likely in segments showing gadolinium enhancement. On the contrary, EPI-LS, EPI-CS and ENDO-CS tend to improve as potential compensatory mechanisms.