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Khanna S, Li C, Amarasekera AT, Bhat A, Chen HHL, Gan GCH, Tan TC. Echocardiographic parameters of cardiac structure and function in the diagnosis of acute myocarditis in adult patients: A systematic review and meta-analysis. Echocardiography 2024; 41:e15760. [PMID: 38345413 DOI: 10.1111/echo.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) plays a key role in the initial work-up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. METHODS A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta-analyzed using a random-effects model for effect size, and assessed through standardized mean difference (SMD). RESULTS Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end-diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) (p ≤ .01 for all). LV-GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46-1.98|). Two studies also demonstrated that impairment in LV-GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. CONCLUSIONS LV-GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. HIGHTLIGHTS What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies. Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end-diastolic diameter can differentiate between myocarditis patients and healthy controls. LV-GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls. Routine assessment of LV-GLS may serve as an important diagnostic tool in the acute care setting.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Anjalee T Amarasekera
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Supeł K, Wieczorkiewicz P, Przybylak K, Zielińska M. 2D Strain Analysis in Myocarditis-Can We Be Any Closer to Diagnose the Acute Phase of the Disease? J Clin Med 2023; 12:jcm12082777. [PMID: 37109114 PMCID: PMC10146770 DOI: 10.3390/jcm12082777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The aim of present study was to assess left ventricular myocardial deformation detected by 2D STE in patients with suspected acute myocarditis (AM) early on admission in whom later cardiac magnetic resonance (CMR) evaluation was performed. METHODS A total of 47 patients with suspected AM based on clinical practice were prospectively enrolled. Coronary angiography was performed on all patients to rule out significant coronary artery disease. CMR confirmed myocardial inflammation, oedema, and regional necrosis meeting the Lake Louise criteria in 25 patients (53%, oedema (+) subgroup). In the remaining patients, only LGE was confirmed in the sub-epicardial or intramuscular localization (22 patients, 47%, oedema (-) subgroup). Early on admission, echocardiography with measurements of global and segmental longitudinal strains (GLS), circumferential strains (GCS) at the endocardial (endocardial GCS) and epicardial (epicardial GCS) layers, transmural GCS, and radial strains (RS) were performed. RESULTS Mild reduction of GLS, GRS, and transmural GCS values were found in patients with oedema (+) subgroup. The epicardial GCS turned out to be the diagnostic factor for oedema with a cut-off point of 13,0% (AUC 0.747, p = 0.0005). Twenty-two patients (all but three) with an acute phase of myocarditis and epicardial GCS -13.0% or less had oedema confirmed by CMR. CONCLUSIONS 2D STE can help to set the diagnosis of AM in patients with acute chest pain with a normal coronary angiogram. The epicardial GCS can serve as a diagnostic factor for oedema in patients with early stage of AM. In patients presenting with signs of AM (oedema in CMR), the epicardial GCS is modified in comparison with a subgroup without oedema; therefore, this parameter could be used to improve the performance of ultrasound.
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Affiliation(s)
- Karolina Supeł
- Department of Interventional Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Paulina Wieczorkiewicz
- Department of Interventional Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Katarzyna Przybylak
- Department of Interventional Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marzenna Zielińska
- Department of Interventional Cardiology, Medical University of Lodz, 90-419 Lodz, Poland
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Goody PR, Zimmer S, Öztürk C, Zimmer A, Kreuz J, Becher MU, Isaak A, Luetkens J, Sugiura A, Jansen F, Nickenig G, Hammerstingl C, Tiyerili V. 3D-speckle-tracking echocardiography correlates with cardiovascular magnetic resonance imaging diagnosis of acute myocarditis – An observational study. IJC HEART & VASCULATURE 2022; 41:101081. [PMID: 35855974 PMCID: PMC9287637 DOI: 10.1016/j.ijcha.2022.101081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023]
Abstract
Regional changes in myocardial texture (as diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. 3D and 2D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF and LVEDV in our patient collective. 3D-speckle-tracking echocardiography offers a promising diagnostic tool in the diagnosis of myocarditis.
Background The diagnostic importance of three-dimensional (3D) speckle-tracking strain-imaging echocardiography in patients with acute myocarditis remains unclear. The aim of this study was to test the diagnostic performance of 3D-speckle-tracking echocardiography compared to CMR (cardiovascular magnetic resonance imaging) for the diagnosis of acute myocarditis. Methods and results 45 patients with clinically suspected myocarditis were enrolled in our study (29% female, mean age: 43.9 ± 16.3 years, peak troponin I level: 1.38 ± 3.51 ng/ml). 3D full-volume echocardiographic images were obtained and offline 2D as well as 3D speckle-tracking analysis of regional and global LV deformation was performed. All patients received CMR scans and myocarditis was diagnosed in 29 subjects based on original Lake-Louise criteria. The 16 patients, in whom myocarditis was excluded by CMR, served as controls. Regional changes in myocardial texture (diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. Interestingly, the 2D and 3D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF (as obtained by echocardiography and CMR) and LVEDV (as obtained by CMR). Conclusions In this study, we examined the use of 3D-speckle-tracking echocardiography in patients with acute myocarditis. Global longitudinal strain was significantly impaired in patients with acute myocarditis and correlated with CMR findings. Therefore, 3D echocardiography could become a useful diagnostic tool in the primary diagnosis of myocarditis.
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Affiliation(s)
- Philip Roger Goody
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Angela Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Kreuz
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Hammerstingl
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
- Corresponding author at: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Venusberg-Campus 1, 53125 Bonn, Germany.
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Khanna S, Amarasekera AT, Li C, Bhat A, Chen HHL, Gan GCH, Ugander M, Tan TC. The utility of cardiac magnetic resonance imaging in the diagnosis of adult patients with acute myocarditis: A systematic review and meta-analysis. Int J Cardiol 2022; 363:225-239. [PMID: 35724801 DOI: 10.1016/j.ijcard.2022.06.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The presence of myocardial late gadolinium enhancement (LGE) indicates myocyte necrosis, and assists with the diagnosis of acute myocarditis (AM). Cardiac magnetic resonance (CMR) measures other than LGE i.e. tissue characterization and myocardial structural and functional parameters, play an important diagnostic role in assessment for inflammation, as seen in AM. The aim of this systematic review was to appraise the evidence for the use of quantitative CMR measures to identify myocardial inflammation in order to diagnose of AM in adult patients. METHODS A systematic literature search of medical databases was performed using PRISMA principles to identify relevant CMR studies on AM in adults (2005-2020; English; PROSPERO registration CRD42020180605). Data for a range of quantitative CMR measures were extracted. Continuous variables with low heterogeneity were meta-analyzed using a random-effects model for overall effect size measured as the standard mean difference (SMD). RESULTS Available data from 25 studies reporting continuous quantitative 1.5 T CMR measures revealed that AM is most reliably differentiated from healthy controls using T1 mapping (SMD 1.80, p < 0.01) and T2 mapping (SMD 1.63, p < 0.01), respectively. All other measures examined including T2-weighted ratio, extracellular volume, early gadolinium enhancement ratio, right ventricular ejection fraction, and LV end-diastolic volume, mass, ejection fraction, longitudinal strain, circumferential strain, and radial strain also had discriminatory ability although with smaller standard mean difference values (|SMD| 0.32-0.96, p < 0.01 for all). CONCLUSIONS Meta-analysis shows that myocardial tissue characterization (T1 mapping>T2 mapping) followed by measures of left ventricular structure and function demonstrate diagnostic discriminatory ability in AM.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anjalee T Amarasekera
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; Western Sydney University, Sydney. NSW, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Martin Ugander
- University of New South Wales, Sydney, NSW, Australia; Kolling Institute, Royal North Shore Hospital, University of Sydney, NSW, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institute, Stockholm, Sweden
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of University, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Western Sydney University, Sydney. NSW, Australia.
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Applying global longitudinal strain in assessing cardiac dysfunction after radiotherapy among breast cancer patients: a systemic review and meta-analysis. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Diagnostic Role of Echocardiographic Strain Analysis in Patients Presenting with Chest Pain and Elevated Troponin: A Multicenter Study. J Am Soc Echocardiogr 2022; 35:857-867. [PMID: 35301094 DOI: 10.1016/j.echo.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Myocarditis presenting as acute chest pain with elevated troponins without significant cardiac compromise is rare in previously healthy children, often referred to as myopericarditis. Diagnosis is challenging as conventional echocardiographic measures of systolic function can be normal. This study aimed to demonstrate the diagnostic utility of strain imaging in this scenario. METHODS This is a multi-center retrospective study including patients presenting with chest pain and elevated troponin from 10 institutions who underwent cardiac MRI (CMR) and transthoracic echocardiogram (echo) within 30 days of each other (group 1). Findings were compared to 19 controls (group 2). Clinical data, conventional echo and CMR data were collected. Echo-derived strain was measured at the core lab. Group 1 was divided into subgroups as CMR myocarditis positive (group 1a) or negative (group 1b) based on established criteria. RESULTS Group 1 included 108 subjects (88 in group 1a, 20 in group 1b). While all groups had normal mean fractional shortening (FS) and mean left ventricular ejection fraction (LVEF), group 1 had significantly lower EF (56.8+/-7.0) compared to group 2 ( 62.3+/- 4.9, P<0.005) and FS (31.2+/- 4.9) compared to group 2 (34.1+/-3.5, p<0.05). Additionally, peak global longitudinal strain (GLS%) was markedly abnormal in group 1 (-13.9+/-3.4 ) compared to group 2 (-19.8+/-2.1 , P<0.001). In subgroup analysis, GLS% was markedly abnormal in group 1a (-13.2 ± 3.0%) compared to group 1b (-17.3 ± 2.6% and p<0.001). Fifty-four subjects had follow up echocardiograms (46 in group 1a, 8 in group 1b) with mean follow-up time of 10 months (SD=11 months). At follow up, while EF and FS returned to normal in all patients, abnormalities in strain persisted in group 1, with 22% of them still having abnormal GLS. Moreover, mean GLS was more abnormal in group 1a (-16.1 +/- 2.6) compared to group 1b (-17.4+/- 1.2, p<0.05). CONCLUSIONS Our study demonstrates that echo GLS% is significantly worse in subjects with myopericarditis presenting with chest pain and elevated troponins compared to controls even when conventional measures of systolic function are largely normal and that these abnormalities persisted overtime.
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Shimoni O, Korenfeld R, Goland S, Meledin V, Haberman D, George J, Shimoni S. Subclinical Myocardial Dysfunction in Patients Recovered from COVID-19 Disease: Correlation with Exercise Capacity. BIOLOGY 2021; 10:biology10111201. [PMID: 34827194 PMCID: PMC8615112 DOI: 10.3390/biology10111201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Aims: Myocardial abnormalities are common during COVID-19 infection and recovery. We examined left (LV) and right (RV) ventricular longitudinal strain in patients who had recovered from COVID-19 and assessed the correlation with exercise capacity. Methods and results: One hundred and eighty-four consecutive patients with history of COVID-19 disease who had been referred to rest or stress echocardiography because of symptoms, mainly dyspnea and chest pain, were included in the study. These patients were compared to 106 patients with similar age, symptoms, and risk factor profile with no history of COVID-19 disease. Clinical and echocardiographic parameters, including strain imaging, were assessed. The patient’s age was 48 ± 12 years. Twenty-two patients had undergone severe disease. There were no differences in the LV ejection fraction and diastolic function between the groups. However, LV and RV global and free wall strain were significantly lower (in absolute numbers) in patients who had recovered form COVID-19 infection (−20.41 ± 2.32 vs −19.39 ± 3.36, p = 0.001, −23.69 ± 3.44 vs −22.09 ± 4.20, p = 0.001 and −27.24 ± 4.7 vs −25.43 ± 4.93, p = 0.021, respectively). Global Longitudinal Strain (GLS) < −20% was present in only 37% of post COVID-19 patients. Sixty-four patients performed exercise echocardiography. Patients with GLS < −20% had higher exercise capacity with higher peak metabolic equivalent and exercise time compared to patients with GLS ≥ −20% (12.6 ± 2 vs 10 ± 2.5 METss and 8:00 ± 2:08 vs 6:24 ± 2:03 min, p < 0.001 and p = 0.003, respectively). Conclusion: In patients, who had recovered from COVID-19 infection, both LV and RV strain are significantly lower compared to control patients. The exercise capacity of these patients correlates with LV strain values. Rest and stress echocardiography in patients with symptoms after COVID-19 infection may identify patients that need further follow up to avoid long term complications of the disease. These preliminary results warrant further research, to test the natural history of these findings and the need and timing of treatment.
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Affiliation(s)
- Or Shimoni
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Roman Korenfeld
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Sorel Goland
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
- Assuta Calaniot Medical Center, Ashdod 7706401, Israel
| | - Valery Meledin
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Dan Haberman
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Jacob George
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
| | - Sara Shimoni
- The Heart Center, Kaplan Medical Center, Rehovot 7661041, Israel; (O.S.); (R.K.); (S.G.); (V.M.); (D.H.); (J.G.)
- Hadassah Medical School, Hebrew University, Jerusalem 9112102, Israel
- Assuta Calaniot Medical Center, Ashdod 7706401, Israel
- Correspondence:
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Usefulness of Left Ventricular Myocardial Deformation in Children Hospitalized for Acute Myocarditis who Develop Arrhythmias. Am J Cardiol 2021; 152:113-119. [PMID: 34148631 PMCID: PMC10103582 DOI: 10.1016/j.amjcard.2021.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
Cardiac arrhythmias occur in 3-40% of patients with acute myocarditis and cause significant morbidity and mortality. Myocardial injury also results in abnormal myocardial deformation. The relationship between left ventricular (LV) deformation, measured by two-dimensional speckle tracking echocardiography (2D-STE), and arrhythmia in pediatric myocarditis is unknown. We evaluated the association between 2D-STE and arrhythmias in children hospitalized with acute myocarditis. We reviewed patients ≤ 18 years hospitalized for acute myocarditis from 2008 to 2018. Arrhythmias were defined as 1) non-sustained or sustained ventricular tachycardia or ventricular fibrillation, 2) sustained supraventricular tachycardia (SVT), 3) high-grade or complete heart block, and 4) any arrhythmia treated with an antiarrhythmic medication. Systolic LV strain values (including LV global longitudinal strain (GLS), global circumferential strain (GCS), and six segments of LV regional long axis strain) were obtained from initial echocardiograms during hospitalization. Of 66 patients hospitalized, 23 (35%) had arrhythmias. SVT was the predominant arrhythmia (74%). Global and regional strain indices were reduced in the arrhythmia group: LV GLS [-8.9 (IQR -13.6, -6.1) vs. -13.7 (IQR -16.9, -9.7), p = 0.038]; basal inferior/septal [-10.7 (IQR -15.5, -7.8) vs. -16.4 (IQR -18, -11.8), p = 0.009]; basal anterior/lateral [-7.1 (IQR -12.8, -4.7) vs. -9.4 (IQR -16.7, -7.4), p = 0.025]; and mid inferior/septal segments [-9 (IQR -13, -7.7) vs. -14.1 (IQR -22.5, -10.7), p = 0.007]. After controlling for age, reductions in GLS and segmental strain in the two basal and two mid-segments were associated with increased arrhythmia occurrence (p <0.05). Our findings suggest that echocardiographic LV deformation by 2D-STE may be useful in identifying pediatric patients with acute myocarditis at risk for arrhythmias.
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Esposito R, Fedele T, Orefice S, Cuomo V, Prastaro M, Canonico ME, Ilardi F, De Stefano F, Fiorillo L, Santoro C, Esposito G. An Emergent Form of Cardiotoxicity: Acute Myocarditis Induced by Immune Checkpoint Inhibitors. Biomolecules 2021; 11:biom11060785. [PMID: 34067474 PMCID: PMC8224544 DOI: 10.3390/biom11060785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. ICIs have shown great promise in the treatment of several advanced malignancies. However, therapy with these immunomodulatory antibodies may lead to a wide spectrum of immune-related adverse events in any organ and any tissue. Cardiologic immune-related events include pericarditis, pericardial effusion, various types of arrhythmias including the occurrence of complete atrioventricular block, myocardial infarction, heart failure, and myocarditis. Although relatively rare, myocarditis is associated with a very high reported mortality in comparison to other adverse events. Myocarditis often presents significant diagnostic complexity and may be under-recognized. When confronted with an unexpected change in the clinical picture, the physician must differentiate between immune-related adverse events, cancer worsening, or other causes unrelated to the cancer or its therapy. However, this is not always easy. Therefore, with the increasing use of checkpoint inhibitors in cancer, all providers who care for patients with cancer should be made aware of this rare, but potentially fatal, cardiologic immune-related adverse event, and able to recognize when prompt consultation with a cardiologist specialist is indicated. In this review, we evaluate currently available scientific evidence and discuss clinical manifestations and new potential approaches to the diagnosis and therapy of acute myocarditis induced by ICIs. Temporary or permanent discontinuation of the ICIs and high-dose steroids have been administered to treat myocarditis, but symptoms may worsen in some patients despite therapy.
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Affiliation(s)
- Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Correspondence: ; Tel.: +39-817-464-749
| | - Teresa Fedele
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Silvia Orefice
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Vittoria Cuomo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Federica Ilardi
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | | | - Ludovica Fiorillo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
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Licordari R, Minutoli F, Recupero A, Campisi M, Donato R, Mazzeo A, Dattilo G, Baldari S, Vita G, Zito C, Di Bella G. Early Impairment of Right Ventricular Morphology and Function in Transthyretin-Related Cardiac Amyloidosis. J Cardiovasc Echogr 2021; 31:17-22. [PMID: 34221881 PMCID: PMC8230159 DOI: 10.4103/jcecho.jcecho_112_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Our study aimed to evaluate right ventricular (RV) morphology and strain (S) in the early stage of familial transthyretin (TTR) cardiac amyloidosis (CA). Methods and Results: Thirty-seven patients with transthyretin mutation underwent 99mTc-3,3-diphosphono-1,2 propanodicarboxylic acid (99mTc-DPD) scans and/or cardiac magnetic resonance (CMR) to identify TTR CA. Each patient underwent echocardiography to quantify RV dimensions, tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), longitudinal (L) strain of the RV free wall, left ventricular (LV) septal thickness (ST), ejection fraction, E/E', LV global (G) L, radial (R), and circumferential (C) S. 99mTc-DPD and CMR revealed the accumulation in 22 of 37 patients (CA group) and no accumulation in 15 patients (no-CA group). Left ventricular (LV) septal thickness (ST) was higher (P < 0.0001) while LV ejection fraction and E/E' were lower (P < 0.05) in the CA group than the no-CA group. LV-global longitudinal strain (LS) was lower (P < 0.0001) in the CA-group than the no CA-group, whereas LV-global circumferential strain and LV-global radial strain were similar. The CA group showed higher values of RV dimensions (P < 0.05) and sPAP (0.02) and a lower (P = 0.002) TAPSE. Globally, RV-LS was lower (P = 0.005) in the CA group than the no-CA group. Basal and mid segments of the RV free wall showed a lower LS in the CA group than the no-CA group (P < 0.01), while apical S was similar between groups. Conclusions: RV deformation, particularly in basal and mid segments, is early impaired in CA.
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Affiliation(s)
- Roberto Licordari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Antonino Recupero
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Mariapaola Campisi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Rocco Donato
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
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Doimo S, Ricci F, Aung N, Cooper J, Boubertakh R, Sanghvi MM, Sinagra G, Petersen SE. Tissue-tracking in the assessment of late gadolinium enhancement in myocarditis and myocardial infarction. Magn Reson Imaging 2020; 73:62-69. [PMID: 32853757 DOI: 10.1016/j.mri.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/21/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To test the diagnostic performance of cardiovascular magnetic resonance (CMR) tissue-tracking (TT) to detect the presence of late gadolinium enhancement (LGE) in patients with a diagnosis of myocardial infarction (MI) or myocarditis (MYO), preserved left ventricular ejection fraction (LVEF) and no visual regional wall motion abnormalities (RWMA). METHODS We selected consecutive CMR studies of 50 MI, 50 MYO and 96 controls. Receiving operating characteristic (ROC) curve and net reclassification index (NRI) analyses were used to assess the predictive ability and the incremental diagnostic yield of 2D and 3D TT-derived strain parameters for the detection of LGE and to measure the best cut-off values of strain parameters. RESULTS Overall, cases showed significantly reduced 2D global longitudinal strain (2D-GLS) values compared with controls (-20.1 ± 3.1% vs -21.6 ± 2.7%; p = 0.0008). 2D-GLS was also significantly reduced in MYO patients compared with healthy controls (-19.7 ± 2.9% vs -21.9 ± 2.4%; p = 0.0001). 3D global radial strain (3D-GRS) was significantly reduced in MI patients compared with controls with risk factors (34.3 ± 11.8% vs 40.3 ± 12.5%, p = 0.024) Overall, 2D-GLS yielded good diagnostic accuracy for the detection of LGE in the MYO subgroup (AUROC 0.79; NRI (95% CI) = 0.6 (0.3, 1.02) p = 0.0004), with incremental predictive value beyond risk factors and LV function parameters (p for AUROC difference = 0.048). In the MI subgroup, 2D-GRS (AUROC 0.81; NRI (95% CI) = 0.56 (0.17, 0.95) p = 0.004), 3D-GRS (AUROC 0.82; NRI (95% CI) = 0.57 (0.17, 0.97) p = 0.006) and 3D global circumferential strain (3D-GCS) (AUROC 0.81; NRI (95% CI) = 0.62 (0.22, 1.01) p = 0.002) emerged as potential markers of disease. The best cut-off for 2D-GLS was -21.1%, for 2D- and 3D-GRS were 39.1% and 37.7%, respectively, and for 3D-GCS was -16.4%. CONCLUSIONS At CMR-tissue tracking analysis, 2D-GLS was a significant predictor of LGE in patients with myocarditis but preserved LVEF and no visual RWMA. Both 2D- and 3D-GRS and 2D-GCS yielded good diagnostic accuracy for LGE detection in patients with previous MI but preserved LVEF and no visual RWMA.
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Affiliation(s)
- Sara Doimo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy.
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy; Department of Clinical Sciences, Malmo, Faculty of Medicine, Lund University, Clinical Research Center, 214 28 Malmo, Sweden; Casa di Cura Villa Serena, Città Sant'Angelo, 65013 Pescara, Italy
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Redha Boubertakh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
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12
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Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance. Sci Rep 2020; 10:11321. [PMID: 32647322 PMCID: PMC7347592 DOI: 10.1038/s41598-020-68048-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/05/2020] [Indexed: 01/01/2023] Open
Abstract
The aim here was to describe the role of speckle tracking echocardiography (STE), in identifying impairment in systolic function in children and adolescents with focal myocarditis and without reduction in ejection fraction. We describe data from 33 pediatric patients (age 4–17 years) admitted for focal myocarditis, confirmed by cardiac magnetic resonance (CMR), and without impaired ejection fraction and/or wall motion abnormalities. All children underwent Doppler echocardiography examination with analysis of global (G) and segmental longitudinal strain (LS) and CMR for the quantification of edema and myocardial fibrosis. Reduction in LS was defined according to age-specific partition values. At baseline, impaired GLS was present in 58% of patients (n = 19), albeit normal ejection fraction. LS was also regionally impaired, according to the area of higher edema at CMR (i.e. most impaired at the level of the infero-lateral segments as compared to other segments (p < 0.05). GLS impairment was also moderately correlated with the percentage edema at CMR (r = − 0.712; p = 0.01). At follow-up, GLS improved in all patients (p < 0.001), and normal values were found in 13/19 patients with baseline reduction. Accordingly persistent global and regional impairment was still observed in 6 patients. Patients with persistent LS reduction demonstrated residual focal cardiac fibrosis at follow-up CMR. Both global and regional LS is able to identify abnormalities in systolic longitudinal mechanics in children and adolescents with focal myocarditis and normal ejection fraction. The reduction in LS is consistent with edema amount and localization at CMR. Furthermore, LS identifies regional recovery or persistent cardiac function impairment, possibly related to residual focal fibrosis.
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Strain analysis reveals subtle systolic dysfunction in confirmed and suspected myocarditis with normal LVEF. A cardiac magnetic resonance study. Clin Res Cardiol 2019; 109:869-880. [PMID: 31828505 DOI: 10.1007/s00392-019-01577-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/18/2019] [Indexed: 12/17/2022]
Abstract
AIMS Lake Louise Criteria (LLC) are time-dependent and some acute myocarditis (AM) with preserved left ventricular ejection fraction (LVEF) could be missed, due to the limited accessibility of Cardiac Magnetic Resonance (CMR). We aimed to assess the potential value of cardiac strain measured by feature tracking (FT) imaging in this population. METHODS AND RESULTS Eighty-three patients with clinically suspected AM and normal LVEF were divided into 39 "confirmed AM" (positive LLC) and 44 "suspected AM" (negative LLC). An age and gender-matched sample of 42 normal subjects underwent CMR. In all groups, FT-derived biventricular strains and STE- global longitudinal strain (GLS) were assessed, being regularly measurable. Strain values < 5th percentile of the control group were considered abnormal. "Suspected" and "confirmed" AM were similar, except for medium time of CMR evaluation (5.2 vs 1 months from presentation, respectively; p = 0.004). Compared to healthy controls, both "suspected" and "confirmed" AM showed significantly impaired strain values. LV-global circumferential strain (GCS), right ventricular GCS and LV-GLS were abnormal in 15.4% and 15.9%, 20.5% and 15.9%, 7.7% and 9.1% in "confirmed" and "suspected" AM, respectively. STE analysis confirmed the results on LV-GLS, however a weak correlation emerged between STE and CMR-FT LV-GLS (p = 0.08). CONCLUSIONS Compared to STE, CMR-FT analysis provided a more comprehensive and complementary biventricular strain evaluation that resulted similar in "confirmed" and "suspected" AM with normal LVEF. Conversely, mostly biventricular GCS was significantly reduced in up to 20% of patients, compared to healthy controls.
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14
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Gursu HA, Cetin II, Azak E, Kibar AE, Surucu M, Orgun A, Pamuk U. The assessment of treatment outcomes in patients with acute viral myocarditis by speckle tracking and tissue Doppler methods. Echocardiography 2019; 36:1666-1674. [DOI: 10.1111/echo.14449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hazım Alper Gursu
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Ibrahim Ilker Cetin
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Emine Azak
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Ayse Esin Kibar
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Ali Orgun
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
| | - Utku Pamuk
- Department of Pediatric Cardiology Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital University of Health Sciences Ankara Turkey
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Mele D, Trevisan F, D'Andrea A, Luisi GA, Smarrazzo V, Pestelli G, Flamigni F, Ferrari R. Speckle Tracking Echocardiography in Non-ST-Segment Elevation Acute Coronary Syndromes. Curr Probl Cardiol 2019; 46:100418. [PMID: 31030854 DOI: 10.1016/j.cpcardiol.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 01/13/2023]
Abstract
Non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) are a group of clinical conditions characterized by acute myocardial ischemia. Conventional echocardiography is generally used to evaluate cardiac function using wall motion analysis and left ventricular ejection fraction but may be insufficient to explore all the complex features of NSTE-ACSs, which may vary substantially from patient to patient in terms of severity of ischemia and extent of involved myocardium. In the last years, speckle tracking echocardiography (STE) has become a widely available technique for the non-invasive assessment of cardiac function and has been repeatedly applied in the setting of NSTE-ACSs. In this review we summarize current evidence about the use of STE in patients with NSTE-ACSs, trying to underline advantages and limitations in comparison with conventional echocardiography for: diagnosis of NSTE-ACS, differential diagnosis, identification of high-risk patients, and prediction of outcome.
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16
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Manalo R, Bourget L, Garg A, Swaminathan S. Does myocardial strain remain abnormal long after normalization of ejection fraction in patients with acute myocarditis? Echocardiography 2019; 36:609-612. [DOI: 10.1111/echo.14260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/05/2018] [Accepted: 12/22/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Rachel Manalo
- Division of Pediatric Cardiology; Holtz Children's Hospital; Jackson Memorial Medical Center; University of Miami Miller School of Medicine; Miami Florida
| | - Laura Bourget
- Division of Pediatric Cardiology; Holtz Children's Hospital; Jackson Memorial Medical Center; University of Miami Miller School of Medicine; Miami Florida
| | - Ashish Garg
- Division of Pediatric Cardiology; Holtz Children's Hospital; Jackson Memorial Medical Center; University of Miami Miller School of Medicine; Miami Florida
| | - Sethuraman Swaminathan
- Division of Pediatric Cardiology; Holtz Children's Hospital; Jackson Memorial Medical Center; University of Miami Miller School of Medicine; Miami Florida
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Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8979407. [PMID: 30627581 PMCID: PMC6304576 DOI: 10.1155/2018/8979407] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.
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18
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Kostakou PM, Kostopoulos VS, Tryfou ES, Giannaris VD, Rodis IE, Olympios CD, Kouris NT. Subclinical left ventricular dysfunction and correlation with regional strain analysis in myocarditis with normal ejection fraction. A new diagnostic criterion. Int J Cardiol 2018; 259:116-121. [PMID: 29579586 DOI: 10.1016/j.ijcard.2018.01.058] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of myocarditis is challenging, especially in case of normal left ventricular systolic function. The aim of this study is to test the hypothesis that 2D speckle tracking echocardiography (2DSTE) can detect subclinical left ventricular (LV) dysfunction in patients with myocarditis and preserved LV function without regional wall motion abnormalities and that regional strain analysis can correlate with cardiac magnetic resonance (CMR) findings. METHODS Study population consisted of 25 consecutive patients with myocarditis and 19 controls. All patients underwent a full echocardiographic study at the first day of their admission and in addition to conventional echocardiographic measurements, global longitudinal and circumferential strain of the left ventricle (LVGLS, LVCS accordingly), as well as regional strains of the lateral wall, were estimated. Moreover, all patients underwent a CMR scan during the first week from their admission. RESULTS Although there was no statistical difference between the two groups of patients in systolic function, myocarditis patients demonstrated significantly impaired LVGLS (-16.5 ± 2.2 vs -20.5 ± 1.3%, p < 0.0001) and LVCS (-16.4 ± 3.7 vs -20.9 ± 2%, p = 0.002), as well as segmental longitudinal strains of the lateral wall. CMR in all myocarditis patients revealed late gadolinium enhancement in the lateral left ventricle free wall. CONCLUSIONS In patients with acute myocarditis with preserved ejection fraction, 2DSTE evaluation appears to be a promising, useful noninvasive and inexpensive tool in addition to existing methods used for the diagnosis of acute myocarditis, since it seems to be able to identify myocardial fibrosis early in the setting of the disease.
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Affiliation(s)
- Peggy M Kostakou
- Cardiology Department, General Hospital of Elefsina "Thriassio", Athens, Greece.
| | | | - Elsi S Tryfou
- Cardiology Department, General Hospital of Elefsina "Thriassio", Athens, Greece
| | | | - Ioannis E Rodis
- Cardiology Department, General Hospital of Elefsina "Thriassio", Athens, Greece
| | | | - Nikos T Kouris
- Cardiology Department, General Hospital of Elefsina "Thriassio", Athens, Greece
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Di Bella G, Carerj S, Recupero A, Donato R, Pugliatti P, Falanga G, Pedri S, Vizzari G, Campisi M, Zito C, de Gregorio C. Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction. Echocardiography 2018; 35:1966-1973. [PMID: 30315606 DOI: 10.1111/echo.14156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of present study was to assess left ventricular (LV) myocardial deformation and changes over time in patients with acute myocarditis (AM) with preserved ejection fraction detected by late gadolinium enhancement (LGE) magnetic resonance imaging. METHODS Thirty-five male patients with AM diagnoses and preserved systolic function based on cardiac magnetic resonance imaging (MRI) were prospectively enrolled. On admission, echocardiography with measurements of global and segmental longitudinal (LS) strains was performed both at the endocardial (ENDO) and epicardial (EPI) levels. Findings were compared to 25 control subjects. Twenty-six patients were also monitored over a 22-month follow-up (FU group). RESULTS On admission, global ENDO-LS was poorer in magnitude 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 P = NS). A functional increase in magnitude in both ENDO-LS (-20.8 ± 5.4, P = NS) and EPI-LS (-22.6 ± 4.6, P = 0.02) was found in FU vs AM patients. CONCLUSIONS The present study demonstrates a steady ENDO-LS impairment in infarct-like AM during a 2-year follow-up period, despite a preserved LV ejection fraction.
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Affiliation(s)
- Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonino Recupero
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Radiological Science, University of Messina, Messina, Italy
| | - Pietro Pugliatti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gabriella Falanga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mariapaola Campisi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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20
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Di Bella G, Pizzino F. Myocardial Deformation Analysis and Late-Gadolinium Enhancement: Important Markers of Cardiac Amyloidosis Involvement That Can Masquerade as a False-Negative Diagnosis. Circ J 2018; 82:2687. [DOI: 10.1253/circj.cj-17-1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina
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21
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Di Bella G, Minutoli F. Atrial impairment in transthyretin cardiac amyloidosis: an early marker of cardiac involvement and a prognostic factor. Amyloid 2018. [PMID: 29523040 DOI: 10.1080/13506129.2018.1450240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Gianluca Di Bella
- a Clinical and Experimental Department of Medicine and Pharmacology , University of Messina , Messina , Italy
| | - Fabio Minutoli
- b Department of Biomedical and Dental Sciences and Morphofunctional Imaging , University of Messina , Messina , Italy
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22
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Wisotzkey BL, Soriano BD, Albers EL, Ferguson M, Buddhe S. Diagnostic role of strain imaging in atypical myocarditis by echocardiography and cardiac MRI. Pediatr Radiol 2018; 48:835-842. [PMID: 29651605 DOI: 10.1007/s00247-017-4061-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/25/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnosis of myocarditis presenting as isolated acute chest pain with elevated troponins but normal systolic function is challenging with significant drawbacks even for the gold-standard endomyocardial biopsy. OBJECTIVE This study aimed to evaluate the diagnostic role of strain imaging by echocardiography and cardiac MRI in these patients. MATERIALS AND METHODS This was a retrospective review of children with cardiac MRI for acute chest pain with elevated troponins compared to normal controls. Echocardiographic fractional shortening, ejection fraction, speckle-tracking-derived peak longitudinal, radial, and circumferential strain were compared to cardiac MRI ejection fraction, T2 imaging, late gadolinium enhancement, speckle-tracking-derived peak longitudinal strain, radial strain, and circumferential strain. RESULTS Group 1 included 10 subjects diagnosed with myocarditis, 9 (90%) males with a median age of 15.5 years (range: 14-17 years) compared with 10 age-matched controls in group 2. All subjects in group 1 had late gadolinium enhancement consistent with myocarditis and troponin ranged from 2.5 to >30 ng/ml. Electrocardiogram changes included ST segment elevation in 6 and abnormal Q waves in 1. Qualitative echocardiographic function was normal in both groups and mean fractional shortening was similar (35±6% in group 1 vs. 34±4% in group 2, P=0.70). Left ventricle ejection fraction by cardiac MRI, however, was lower in group 1 (52±9%) compared to group 2 at (59±4%) (P=0.03). Cardiac MRI derived strain was lower in group 1 vs. group 2 for speckle-tracking-derived peak longitudinal strain (-12.8±2.8% vs. -17.1±1.5%, P=0.001), circumferential strain (-12.3±3.8% vs. -15.8±1.2%, P=0.020) and radial strain (13.6±3.7% vs. 17.2±3.2%, P=0.040). Echocardiography derived strain was also lower in group 1 vs. group 2 for speckle-tracking-derived peak longitudinal strain (-15.6±3.9% vs. -20.8±2.2%, P<0.002), circumferential strain (-16±3% vs. -19.8±1.9%, P<0.003) and radial strain (17.3±6.1% vs. 24.8±6.3%, P=0.010). CONCLUSION In previously asymptomatic children, myocarditis can present with symptoms of acute chest pain suspicious for coronary ischemia. Cardiac MRI and echocardiographic strain imaging are noninvasive, radiation-free tests of immense diagnostic utility in these situations. Long-term studies are needed to assess prognostic significance of these findings.
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Affiliation(s)
- Bethany L Wisotzkey
- Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, 501 Sixth Avenue South, St. Petersburg, FL, 33701, USA.
| | - Brian D Soriano
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Mark Ferguson
- Division of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Sujatha Buddhe
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
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Advanced Non-invasive Imaging Techniques in Chronic Heart Failure and Cardiomyopathies : Focus on Cardiac Magnetic Resonance Imaging and Computed Tomographic. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 29498024 DOI: 10.1007/5584_2018_183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Cardiomyopathies (Cs) are a heterogeneous group of myocardial diseases with structural and/or functional abnormalities.The aetiology is due to genetic-family substrate in most cases, however, the correct and detailed analysis of morphofunctional abnormalities (severity and distribution of hypertrophy, ventricular dilatation, ventricular dysfunction) and tissue characteristics (myocardial fibrosis, myocardial infiltration) are a crucial element for a definite diagnosis.Among the different diagnostic imaging modalities applied in clinical practice (echocardiography, nuclear medicine), cardiac magnetic resonance (CMR) has emerged as a non-invasive diagnostic tool having high ability to quantify systolic function and tissue abnormalities that represent the substrates of many Cs.The main added value of CMR is the ability to identify cardiomyopathies with respect to ischemic heart disease and, above all, to discriminate the major types of cardiomyopathies based on morpho-functional presentation patterns and the presence and location of myocardial fibrosis.Many CMR elements allow increasing diagnostic accuracy but CMR data should be integrated with an appropriate clinical and instrumental context.Computed Tomographic (CT) scan technology has showed a complementary role in patients having Cs and HF.In this chapter, the diagnostic, pathophysiologic and prognostic value of CMR and CT in heart failure due to the most common cardiomyopathies will be discussed.
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Pizzino F, Recupero A, Pugliatti P, Maffei S, Di Bella G. RE: Multi-Parameter CMR Approach in Acute Myocarditis to Improve Diagnosis and Prognostic Stratification. Korean J Radiol 2018. [PMID: 29520196 PMCID: PMC5840067 DOI: 10.3348/kjr.2018.19.2.366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Fausto Pizzino
- Fondazione Toscana Gabriele Monasterio, UO Patologie Mediche e Chirurgiche del Cuore, Massa, CAP 54100, Italy
| | - Antonino Recupero
- Clinical and Experimental Department of Medicine, University of Messina, Messina, CAP 98125, Italy
| | - Pietro Pugliatti
- Clinical and Experimental Department of Medicine, University of Messina, Messina, CAP 98125, Italy
| | - Stefano Maffei
- Fondazione Toscana Gabriele Monasterio, UO Patologie Mediche e Chirurgiche del Cuore, Massa, CAP 54100, Italy
| | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, Messina, CAP 98125, Italy
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Leitman M, Vered Z, Tyomkin V, Macogon B, Moravsky G, Peleg E, Copel L. Speckle tracking imaging in inflammatory heart diseases. Int J Cardiovasc Imaging 2017; 34:787-792. [PMID: 29181826 DOI: 10.1007/s10554-017-1284-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/22/2017] [Indexed: 11/30/2022]
Abstract
Accurate diagnosis of acute myocarditis is important for the prognosis and risk stratification of these patients. Cardiac magnetic resonance (CMR) has become a major modality for diagnosis of myocarditis, but not widely available. In this study, we tried to evaluate regional and global longitudinal strain by speckle tracking echocardiography in patients with acute inflammatory myocardial diseases in correlation with CMR. Patients with suspected acute myocarditis were recruited prospectively. Clinical diagnosis was established based on clinical, electrocardiographic, laboratory and conventional echocardiographic data. All patients underwent CMR and repeat echocardiographic examination within 24 h of CMR. Echocardiographic examinations were analyzed offline with speckle tracking imaging software. Thirty-two patients with acute perimyocarditis and myopericarditis were included. Mean age was 29 ± 8, 30 males. All patients presented with chest pain and an abnormal electrocardiogram, in 28 ST elevation was found. Troponin was elevated in 30 and was 0.7 ± 0.5 ng/ml. Creatine kinase was 487 ± 319 U. LVEF was 56 ± 5%. Wall motion abnormalities were present in postero-lateral (53%), and inferior wall (21%). Delayed enhancement on CMR was found in 29 patients. Echocardiographic EF based on speckle tracking imaging correlated with CMR calculated EF. There was a positive correlation between the amplitude of regional strain and delayed enhancement, r = 0.52. Sensitivity and specificity of regional strain for prediction of delayed enhancement was 85 and 73% respectively. Speckle tracking imaging can help in the diagnosis of acute myocarditis when CMR is not readily available. Speckle tracking imaging based EF correlates with CMR calculated LVEF and with global strain.
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Affiliation(s)
- Marina Leitman
- Department of Cardiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Zvi Vered
- Department of Cardiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vladimir Tyomkin
- Department of Cardiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel
| | - Boris Macogon
- Department of Radiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Moravsky
- Department of Cardiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Peleg
- Department of Cardiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurian Copel
- Department of Radiology, Assaf Harofeh Medical Center, 70300, Tzrifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Baeßler B, Treutlein M, Schaarschmidt F, Stehning C, Schnackenburg B, Michels G, Maintz D, Bunck AC. A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking. J Cardiovasc Magn Reson 2017; 19:71. [PMID: 28931401 PMCID: PMC5607501 DOI: 10.1186/s12968-017-0387-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/12/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (CMR) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional Lake Louise criteria (LLC). METHODS CMR data from 67 patients with suspected acute myocarditis were retrospectively analyzed. Seventeen age- and gender-matched healthy subjects served as control. T2-mapping data were acquired using a Gradient-Spin-Echo T2-mapping sequence in short-axis orientation. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values and pixel-standard deviation (SD) were recorded. Afterwards, the parameters maxT2 (the highest segmental T2 value) and madSD (the mean absolute deviation (MAD) of the pixel-SDs) were calculated for each subject. Cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. RESULTS A multiparametric imaging model containing madSD and LV global circumferential strain (GCSLV) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [AUC] 0.84) when compared to any model containing a single imaging parameter or to LLC (AUC 0.79). Adding late gadolinium enhancement (LGE) to the model resulted in a further increased diagnostic performance (AUC 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. CONCLUSIONS A multiparametric CMR imaging model including the novel T2-mapping derived parameter madSD, the feature tracking derived strain parameter GCSLV and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Melanie Treutlein
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Hannover, Germany
| | | | | | - Guido Michels
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander C. Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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Late Detection of Left Ventricular Dysfunction Using Two-Dimensional and Three-Dimensional Speckle-Tracking Echocardiography in Patients with History of Nonsevere Acute Myocarditis. J Am Soc Echocardiogr 2017; 30:756-762. [DOI: 10.1016/j.echo.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 02/06/2023]
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Kasner M, Aleksandrov A, Escher F, Al-Saadi N, Makowski M, Spillmann F, Genger M, Schultheiss HP, Kühl U, Pieske B, Morris DA, Noutsias M, Tschöpe C. Multimodality imaging approach in the diagnosis of chronic myocarditis with preserved left ventricular ejection fraction (MCpEF): The role of 2D speckle-tracking echocardiography. Int J Cardiol 2017; 243:374-378. [PMID: 28536004 DOI: 10.1016/j.ijcard.2017.05.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/03/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
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 48h 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).
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Affiliation(s)
- Mario Kasner
- Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aleksandar Aleksandrov
- Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Felicitas Escher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Nidal Al-Saadi
- Private Institute for Cardiovascular Medicine, Berlin, Germany
| | - Markus Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Frank Spillmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Martin Genger
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | | | - Uwe Kühl
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Center: Berlin, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pulmonology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Center: Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.
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Di Bella G, Minutoli F, Piaggi P, Casale M, Mazzeo A, Zito C, Oreto G, Baldari S, Vita G, Pingitore A, Khandheria BK, Carerj S. Quantitative Comparison Between Amyloid Deposition Detected by (99m)Tc-Diphosphonate Imaging and Myocardial Deformation Evaluated by Strain Echocardiography in Transthyretin-Related Cardiac Amyloidosis. Circ J 2016; 80:1998-2003. [PMID: 27477961 DOI: 10.1253/circj.cj-16-0209] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Management of cardiac amyloidosis (CA) is related to amyloid deposition. Our aim was to assess the effect of amyloid deposition on myocardial function. METHODS AND RESULTS Twenty-eight patients with transthyretin mutation and a group of 14 controls underwent echocardiography to quantify left ventricular (LV) dimensions, function, and global (G) longitudinal (L), radial (R) and circumferential (C) strain (S). (99m)Tc-3,3-diphosphono-1,2-propanodicarboxylic-acid-scintigraphy ((99m)Tc-DPD) was used to quantify CA. (99m)Tc-DPD revealed accumulation in 14/28 patients (CA group) and no accumulation (no-CA group) in 14. Cardiac accumulation was lower-than-bone uptake in 5 (mild-CA group) and higher-than-bone uptake in 9 (severe-CA group). Ejection fraction was similar among groups. GLS was lower (P<0.001) in the severe-CA group (-12.2±4.5) with respect to the no-CA group (-19.3±3.0) and to the control group (-20.9±2.5). Conversely, GCS and GRS were lower (P<0.05) in the mild-CA group (-10.8±4.1 and 9.5±5.7, respectively) with respect to the severe-CA group (-18.9±5.1 and 23.9±6.3 respectively), no-CA group (-19.2±4.1 and 28.4±10.2, respectively) and the control group (-23.9±4.4 and 29.9±8.7, respectively). A correlation was found between the scintigraphic heart retention index (HRI) and LV septal thickness (ρ=0.72), E/E' (ρ=0.46) and GLS (ρ=-0.40). CONCLUSIONS Myocardial deformation is impaired in a different stage of CA. The (99m)Tc-DPD HRI correlated well with morphologic, diastolic and strain abnormalities. (Circ J 2016; 80: 1998-2003).
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino"
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André F, Stock FT, Riffel J, Giannitsis E, Steen H, Scharhag J, Katus HA, Buss SJ. Incremental value of cardiac deformation analysis in acute myocarditis: a cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 2016; 32:1093-101. [PMID: 27100527 DOI: 10.1007/s10554-016-0878-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
The aim of this study was to assess cardiac deformation patterns in myocarditis applying feature tracking imaging (FTI) to cardiovascular magnetic resonance (CMR) images. Thirty-six patients (31 males) with acute myocarditis and 36 age- and gender-matched healthy volunteers were studied. CMR examinations were performed in a 1.5 T MR-scanner including late gadolinium enhancement (LGE). FTI was applied to standard cine images of long and short axis views. Global peak circumferential, longitudinal and radial systolic strains as well as long axis strain (LAS) were measured. Patients showed significantly impaired global peak circumferential (-24.4 ± 4.2 % vs. -28.8 ± 3.8 %, p < 0.0001), longitudinal (-17.6 ± 4.4 % vs. -23.8 ± 3.1 %, p < 0.0001) and radial (26.1 ± 5.4 % vs. 37.9 ± 7.6 %, p < 0.0001) systolic strains. Even patients with a preserved ejection fraction (pEF, ≥55 %) had significantly reduced longitudinal (-20.0 ± 4.8 % vs. -23.8 ± 3.1 %, p < 0.01) and radial (27.7 ± 5.5 % vs. 37.9 ± 7.6 %, p < 0.0001) strains. The extent of LGE in patients did not correlate to their respective strains. Regarding the differentiation between patients and controls, the addition of global peak systolic strains to ejection fraction led to a significant improvement of the logistic regression model (χ(2) 48.7 vs. 71.5; p < 0.001) resulting in a high AUC of 0.98. Applying previously published reference values, 75 % or 31 % of patients with pEF showed at least one strain value or a LAS, which fell below the limit of 1 or respectively 2 standard deviations from the reference mean value. Cardiac strains measured by CMR-FTI are significantly impaired in patients with acute myocarditis even in those with pEF. Therefore, strain assessment may improve the diagnostic accuracy of CMR for myocarditis.
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Affiliation(s)
- Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Florian T Stock
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Henning Steen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jürgen Scharhag
- Institute for Sports and Preventive Medicine, Saarland University, Campus Geb. B8 2, 66123, Saarbrücken, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Di Bella G, Minutoli F, Madaffari A, Mazzeo A, Russo M, Donato R, Zito C, Aquaro GD, Piccione MC, Pedri S, Vita G, Pingitore A, Carerj S. Left atrial function in cardiac amyloidosis. J Cardiovasc Med (Hagerstown) 2016; 17:113-21. [DOI: 10.2459/jcm.0000000000000188] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Diagnostic implications of magnetic resonance feature tracking derived myocardial strain parameters in acute myocarditis. Eur J Radiol 2015; 85:218-227. [PMID: 26724669 DOI: 10.1016/j.ejrad.2015.11.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/23/2015] [Accepted: 11/14/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE The present study aims to evaluate the diagnostic value of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain-analysis of both ventricles in patients with acute myocarditis (ACM) in order to improve its currently still challenging non-invasive diagnosis. METHODS CMR cine data of 31 patients with clinically suspected ACM and confirmation of diagnosis by CMR according to the Lake Louise criteria as well as 14 patients with clinically diagnosed ACM but inconspicuous CMR were retrospectively analyzed. 20 healthy volunteers (HV) served as a control. Analysis of global longitudinal, circumferential and radial strain and strain rate of both ventricles was performed in one long-axis and three short-axis slices using a dedicated FT-software (TomTec Imaging Systems). RESULTS Patients with ACM showed significantly reduced LV longitudinal strain (-12.7 ± 6.5 vs. -16.8 ± 5.9%, p=0.021) and LV circumferential strain (LVCirStrain; -22.9 ± 5.7 vs. -27.8 ± 4.4 %, p<0.001) compared to HV. Conversely, they showed improved basal RV circumferential strain rate (BasalRVCirSR; -0.70 ± 0.23 vs. -0.47 ± 0.31s(-1), p=0.009). In ACM patients with preserved EF, BasalRVCirSR was significantly increased compared to HV while LV strain was not significantly different between both groups. In multinominal logistic regression analysis, LVCirStrain and BasalRVCirSR proved to be the best independent predictors of ACM with preserved EF. A combined cut-off of -0.53s(-1) for BasalRVCirSR and of -29.0% for LVCirStrain allowed a classification of ACM patients with preserved EF with a sensitivity of 89% and a specificity of 80%. Also patients with clinical ACM but inconspicuous CMR showed a significantly improved BasalRVCirSR and a cut-off of -0.77s(-1) allowed a classification of ACM patients with a sensitivity of 70% and a specificity of 90%, while all other CMR parameters were normal. CONCLUSIONS The defined cut-offs for LVCirStrain and BasalRVCirSR allow a prediction of ACM with high sensitivity and specificity, even in patients with preserved EF and in patients with otherwise completely inconspicuous CMR. Our results point to a discriminative power especially of RV strain analysis in the CMR-based diagnosis of ACM.
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Palmieri V, Innocenti F, Guzzo A, Guerrini E, Vignaroli D, Pini R. Left Ventricular Systolic Longitudinal Function as Predictor of Outcome in Patients With Sepsis. Circ Cardiovasc Imaging 2015; 8:e003865; discussion e003865. [DOI: 10.1161/circimaging.115.003865] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Vittorio Palmieri
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
| | - Francesca Innocenti
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
| | - Aurelia Guzzo
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
| | - Elisa Guerrini
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
| | - Damiano Vignaroli
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
| | - Riccardo Pini
- From the Cardiology Unit, Department of Heart and Vessels, SG Moscati National Hospital, Avellino, Italy (V.P.); and Emergency Department–High Dependency Observation Unit, Department of Clinical and Experimental Medicine, Careggi University-Hospital, Florence, Italy (F.I., A.G., E.G., D.V., R.P.)
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Iizuka K, Yamaki N, Hisaki Y, Takizawa H. [The Impact That SPECT Collection Angle and Collection Orbit Gives to an Image: Myocardial Digital Phantom Study]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2015; 71:520-6. [PMID: 26155808 DOI: 10.6009/jjrt.2015_jsrt_71.6.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE We evaluated the effect that collection angle and collection orbit condition gave to an image quantitatively by simulating the single photon emission computed tomography (SPECT) system. METHOD Using the Software Package of the Nuclear Medicine Data Processor for Research, we performed making of the myocardial digital phantom, three ways of different simulation of the collection angle and collection orbit, and making of reference of the uniform picture element level. We calculated NMSE for uniformity evaluation and calculated myocardial thickness full width at half maximum (FWHM) for a spatial resolution evaluation. RESULTS 360 degrees circular orbit collection had best uniformity. 180 degrees noncircular orbit collection had best spatial resolution. CONCLUSION By using the digital phantom, we focused on only collection angle and collection orbit condition, and focused on two indexes of the uniformity and the spatial resolution and were able to show a quantitative index.
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Affiliation(s)
- Kazunori Iizuka
- Department of Radiology, National Hospital Organization Matsumoto Medical Center
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Uppu SC, Shah A, Weigand J, Nielsen JC, Ko HH, Parness IA, Srivastava S. Two-dimensional speckle-tracking-derived segmental peak systolic longitudinal strain identifies regional myocardial involvement in patients with myocarditis and normal global left ventricular systolic function. Pediatr Cardiol 2015; 36:950-9. [PMID: 25617227 DOI: 10.1007/s00246-015-1105-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/09/2015] [Indexed: 01/13/2023]
Abstract
The presence of myocardial late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in concert with electrocardiography and elevated biomarkers helps support the diagnosis of acute myocarditis. Two-dimensional echocardiography is limited to global and qualitative regional function assessment and may not contribute to the diagnosis, especially in the presence of normal LV systolic function. Two-dimensional speckle-tracking (2D-STE)-derived segmental peak systolic (pkS) longitudinal strain (LS) may identify segmental myocardial involvement in myocarditis. We sought to identify an association between segmental pkS, LGE, and troponin levels in patients with myocarditis. Retrospective analysis of myocardial segmental function by 2D-STE segmental strain was compared to the presence of LGE and admission peak troponin levels in patients with acute myocarditis and preserved global LV systolic function. American Heart Association 17-segment model was used for comparison between imaging modalities. Global function was assessed by m-mode-derived shortening fraction (SF). Descriptive statistics and regression analysis were utilized. Forty-four CMRs performed to evaluate for myocarditis were identified. Of the 44, 10 patients, median age 17.5 years (14-18.5 years) and median SF 35 % (28-44 %), had paired CMR and 2D-STE data for analysis, and 161/170 segments could be analyzed by both methods for comparison. PkS LS was decreased in 51 % of segments that were positive for LGE with average pkS of -14.7 %. Segmental pkS LS abnormalities were present in all but one patient who had abnormal pkS circumferential strain. Global pkS LS was decreased in patients with myocarditis. There is a moderate correlation between decreased pkS LS and the presence of LGE by CMR, 2D-STE for myocardial involvement in acute myocarditis can serve as an useful noninvasive adjunct to the existing tests used for the diagnosis of acute myocarditis and might have a role in prognostication.
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Affiliation(s)
- Santosh C Uppu
- Division of Pediatric Cardiology, Mount Sinai School of Medicine, Box 1201, One Gustave L. Levy Place, New York, NY, 10029, USA,
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Di Bella G, Oreto L, Oreto G. Letter by Di Bella et al. regarding the article "Agreement between ST elevation and late enhancement evaluated by MRI in patients with acute myocarditis". J Electrocardiol 2014; 47:954-5. [PMID: 25172191 DOI: 10.1016/j.jelectrocard.2014.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
| | - Lilia Oreto
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Giuseppe Oreto
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
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Heart involvement in rheumatoid arthritis: multimodality imaging and the emerging role of cardiac magnetic resonance. Semin Arthritis Rheum 2013; 43:314-24. [PMID: 23786873 DOI: 10.1016/j.semarthrit.2013.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) exhibit a high risk of cardiovascular disease (CVD). CVD in RA can present in many guises, commonly detected at a subclinical level only. METHODS Modern imaging modalities that allow the noninvasive assessment of myocardial performance and are able to identify cardiac abnormalities in early asymptomatic stages may be useful tools in terms of screening, diagnostic evaluation, and risk stratification in RA. RESULTS The currently used imaging techniques are echocardiography, single-photon emission computed tomography (SPECT), and cardiac magnetic resonance (CMR). Between them, echocardiography provides information about cardiac function, valves, and perfusion; SPECT provides information about myocardial perfusion and carries a high amount of radiation; and CMR-the most promising imaging modality-evaluates myocardial function, inflammation, microvascular dysfunction, valvular disease, perfusion, and presence of scar. Depending on availability, expertise, and clinical queries, "right technique should be applied for the right patient at the right time." CONCLUSIONS In this review, we present a short overview of CVD in RA focusing on the clinical implication of multimodality imaging and mainly on the evolving role of CMR in identifying high-risk patients who could benefit from prevention strategies and early specific treatment targeting the heart. Advantages and disadvantages of each imaging technique in the evaluation of RA are discussed.
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Sengupta SP, Nugurwar A, Jaju R, Khandheria BK. Left ventricular myocardial performance in patients with dengue hemorrhagic fever and thrombocytopenia as assessed by two-dimensional speckle tracking echocardiography. Indian Heart J 2013; 65:276-82. [PMID: 23809381 DOI: 10.1016/j.ihj.2013.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/13/2013] [Accepted: 04/03/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We obtained longitudinal, radial and circumferential strains in patients with dengue hemorrhagic fever (DhF) and thrombocytopenia using two-dimensional (2D) speckle tracking echocardiography to analyze left ventricular (LV) myocardial performance. METHODS In this prospective study, 2D echocardiographic images of the left ventricle in the four-, three- and two-chamber views and parasternal short-axis views at the basal, mid and apical levels were obtained in 40 subjects: 20 patients (23 ± 8 years, 12 male) with DhF and thrombocytopenia and 20 healthy controls (23 ± 5 years, 11 male). Of the 20 patients, imaging was performed again in 19 at discharge after a hospital stay of 8 ± 1 days. Longitudinal, circumferential and radial strains were quantified and compared in an 18-segment model using a novel speckle tracking system. RESULTS Left ventricular global ejection fraction was reduced in patients with DhF at presentation as compared with controls (51.25 ± 0.96% vs. 59.32 ± 1.26%; p = 0.032). Peak longitudinal strain in patients with DhF was significantly attenuated in the subendocardial region compared with normal controls (p < 0.001). A significant increase in circumferential strain for patients with DhF was evident only in the subepicardial region (p = 0.009). Patients with DhF showed significantly higher radial strain than controls (p < 0.001). On multivariate analysis, subendocardial longitudinal strain independently predicted the duration of hospital stay in patients with DhF. CONCLUSION Assessment of speckle tracking echocardiography-derived LV mechanics helps in understanding myocardial mechanics in patients with DhF and thrombocytopenia. Identification of reduced LV longitudinal strain helps in understanding the mechanism of reduced LV myocardial performance seen in patients with DhF.
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New echocardiographic findings correlate with intramyocardial inflammation in endomyocardial biopsies of patients with acute myocarditis and inflammatory cardiomyopathy. Mediators Inflamm 2013; 2013:875420. [PMID: 23576857 PMCID: PMC3616345 DOI: 10.1155/2013/875420] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 02/02/2013] [Accepted: 02/18/2013] [Indexed: 01/20/2023] Open
Abstract
Background. The diagnosis of acute myocarditis (AMC) and inflammatory cardiomyopathy (DCMi) can be difficult. Speckle tracking echocardiography with accurate assessments of regional contractility could have an outstanding importance for the diagnosis. Methods and Results. N = 25 patients with clinically diagnosed AMC who underwent endomyocardial biopsies (EMBs) were studied prospectively. Speckle tracking imaging was examined at the beginning and during a mean follow-up period of 6.2 months. In the acute phase patients had markedly decreased left ventricular (LV) systolic function (mean LV ejection fraction (LVEF) 40.4 ± 10.3%). At follow-up in n = 8 patients, inflammation persists, correlating with a significantly reduced fractional shortening (FS, 21.5 ± 6.0%) in contrast to those without inflammation in EMB (FS 32.1 ± 7.1%, P < 0.05). All AMC patients showed a reduction in global systolic longitudinal strain (LS, −8.36 ± −3.47%) and strain rate (LSR, 0.53 ± 0.29 1/s). At follow-up, LS and LRS were significantly lower in patients with inflammation, in contrast to patients without inflammation (−9.4 ± 1.4 versus −16.8 ± 2.0%, P < 0.0001; 0.78 ± 0.4 versus 1.3 ± 0.3 1/s). LSR and LS correlate significantly with lymphocytic infiltrates (for CD3 r = 0.7, P < 0.0001, and LFA-1 r = 0.8, P < 0.0001). Conclusion. Speckle tracking echocardiography is a useful adjunctive assisting tool for evaluation over the course of intramyocardial inflammation in patients with AMC and DCMi.
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Truong UT, Sun HY, Tacy TA. Myocardial deformation in the fetal single ventricle. J Am Soc Echocardiogr 2012; 26:57-63. [PMID: 23140844 DOI: 10.1016/j.echo.2012.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In postnatal life, patients with single ventricle (SV) with morphologic right ventricles have a worse prognosis than those with morphologic left ventricles. The aim of this study was to test the hypotheses that (1) the SV in fetuses with SV has decreased longitudinal strain compared with fetuses with normal cardiac anatomy, and (2) fetuses with SV right ventricular (RV) morphology have decreased strain compared with those with SV left ventricular (LV) morphology. METHODS Fetal echocardiograms with SV RV and SV LV morphology were retrospectively compiled. Postprocessing analysis of the dominant ventricle was done using syngo Velocity Vector Imaging version 2.0. Peak global longitudinal strain (GLS) and global longitudinal strain rate (GL SR) were generated. Both the right and left ventricles were analyzed in fetuses with normal cardiac anatomy for comparison. RESULTS Fifty-four fetuses with SV (18 with LV morphology and 36 with RV morphology) were included in the study and compared with 54 controls matched for gestational age. Global longitudinal strain and GL SR were compared between fetuses with SV and normal fetuses and among SV subsets. When all four categories were compared (normal left ventricle, normal right ventricle, SV left ventricle, and SV right ventricle), there was no difference in GLS (P = .49) or in GL SR (P = .32) between any of the categories. CONCLUSIONS Comparable GLS and GL SR values between fetal SV of LV or RV morphology, as well as normal fetal left and right ventricles, reflect in utero preservation of systolic function of the SV heart.
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Affiliation(s)
- Uyen T Truong
- Division of Pediatric Cardiology, Children's Hospital Colorado, The University of Colorado Medical Center, Aurora, Colorado, USA
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New findings and the role of cardiac imaging in myocarditis and related induced cardiomyopathy. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Altered Left Ventricular Tissue Velocities, Deformation and Twist in Children and Young Adults with Acute Myocarditis and Normal Ejection Fraction. J Am Soc Echocardiogr 2012; 25:294-303. [DOI: 10.1016/j.echo.2011.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Indexed: 01/31/2023]
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Nakamori S, Matsuoka K, Onishi K, Kurita T, Ichikawa Y, Nakajima H, Ishida M, Kitagawa K, Tanigawa T, Nakamura T, Ito M, Sakuma H. Prevalence and signal characteristics of late gadolinium enhancement on contrast-enhanced magnetic resonance imaging in patients with takotsubo cardiomyopathy. Circ J 2012; 76:914-21. [PMID: 22293447 DOI: 10.1253/circj.cj-11-1043] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND To determine the prevalence and signal intensity (SI) characteristics of late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI) in takotsubo cardiomyopathy (TC). METHODS AND RESULTS Cine, black-blood T2-weighted and LGE MR images were acquired in 23 patients with TC within 72 h of onset. Wall motion abnormality (WMA), edema and LGE were evaluated with a 16-segment model. The SI characteristics of LGE were analyzed using SI distribution in remote normal segments as reference. Follow-up MRI was performed 3 months later. Retrospective analysis of LGE MRI was also performed in 10 patients with acute myocardial infarction (AMI) to compare the SI characteristics between TC and AMI. In acute phase, WMA and edema were observed in 236 (64%) and 205 (56%) of 368 segments. LGE was observed in 10 (2.7%) of 368 segments and in 5 (22%) of 23 patients. All LGE lesions in TC exhibited transmural enhancement. The contrast-to-noise ratio (CNR) in TC was significantly lower than that of AMI (3.1±0.3 standard deviations (SD) vs. 6.1±1.2 SD, P<0.01), and CNR value of 4 was useful for distinguishing TC from AMI. Both LGE and WMA disappeared within 12 months. CONCLUSIONS Grey myocardial signal on LGE MRI may be observed in patients with TC. However, the extent of LGE is substantially less than that of WMA and edema, and disappears within 12 months.
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Affiliation(s)
- Shiro Nakamori
- Department of Cardiology, Matsusaka Central Hospital, Matsusaka, Japan
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Pingitore A, Garbella E, Piaggi P, Menicucci D, Frassi F, Lionetti V, Piarulli A, Catapano G, Lubrano V, Passera M, Di Bella G, Castagnini C, Pellegrini S, Metelli MR, Bedini R, Gemignani A, L'Abbate A. Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence. Am J Physiol Heart Circ Physiol 2011; 301:H2161-7. [PMID: 21873499 DOI: 10.1152/ajpheart.00388.2011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Whether prolonged strenuous exercise performed by athletes at sea level can produce interstitial pulmonary edema is under debate. Chest sonography allows to estimate extravascular lung water, creating ultrasound lung comet-tail (ULC) artifacts. The aim of the study was to determine whether pulmonary water content increases in Ironmen (n = 31) during race at sea level and its correlation with cardiopulmonary function and systemic proinflammatory and cardiac biohumoral markers. A multiple factor analysis approach was used to determine the relations between systemic modifications and ULCs by assessing correlations among variables and groups of variables showing significant pre-post changes. All athletes were asymptomatic for cough and dyspnea at rest and after the race. Immediately after the race, a score of more than five comet tail artifacts, the threshold for a significant detection, was present in 23 athletes (74%; 16.3 ± 11.2; P < 0.01 ULC after the race vs. rest) but decreased 12 h after the end of the race (13 athletes; 42%; 6.3 ± 8.0; P < 0.01 vs. soon after the race). Multiple factor analysis showed significant correlations between ULCs and cardiac-related variables and NH(2)-terminal pro-brain natriuretic peptide. Healthy athletes developed subclinical increase in pulmonary water content immediately after an Ironman race at sea level, as shown by the increased number of ULCs related to cardiac changes occurring during exercise. Hemodynamic changes are one of several potential factors contributing to the mechanisms of ULCs.
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Di Bella G, Minutoli F, Pingitore A, Zito C, Mazzeo A, Aquaro GD, Di Leo R, Recupero A, Stancanelli C, Baldari S, Vita G, Carerj S. Endocardial and epicardial deformations in cardiac amyloidosis and hypertrophic cardiomyopathy. Circ J 2011; 75:1200-8. [PMID: 21427499 DOI: 10.1253/circj.cj-10-0844] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to analyze epicardial (EPI) and endocardial (ENDO) strain (S) in patients with transthyretin-related cardiac amyloidosis (TTR-CA) and hypertrophic cardiomyopathy (HCM) using echocardiography (TTE) with 2-dimensional feature tracking imaging (FTI). METHODS AND RESULTS Thirty-three subjects (11 with HCM, 11 with TTR-CA, and 11 healthy subjects as controls) with a New York Heart Association functional class ≤ II underwent conventional TTE and FTI. TTE was used for the evaluation of left ventricle (LV) wall thickness, mass, systolic and diastolic function. FTI was used for the evaluation of EPI and ENDO longitudinal, and circumferential, and radial S. LV wall thickness and mass were higher in both TTR-CA and HCM in comparison with controls (P < 0.001), but ejection fraction (EF) was similar among patients with TTR-CA, HCM and controls (63 ± 6%, 64 ± 6%, 61 ± 5%, respectively). ENDO and EPI longitudinal and circumferential S and radial S were significantly lower in HCM and TTR-CA when compared with controls (P < 0.01). No differences in EPI and ENDO longitudinal S, ENDO circumferential S and radial S were found between TTR-CA and HCM groups, while EPI circumferential S was significantly lower in the TTRCA group (6 ± 3.3%) than in the HCM group (8.1 ± 4.3%; P < 0.0001). CONCLUSIONS Longitudinal, circumferential and radial LV deformations are impaired in patients with TTR-CA and HCM with a preserved EF. Impairment of EPI circumferential strain is greater in TTR-CA than in HCM.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Italy.
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Ichikawa R, Sumitomo N, Komori A, Abe Y, Nakamura T, Fukuhara J, Matsumura M, Miyashita M, Kanamaru H, Ayusawa M, Mugishima H. The follow-up evaluation of electrocardiogram and arrhythmias in children with fulminant myocarditis. Circ J 2011; 75:932-8. [PMID: 21343655 DOI: 10.1253/circj.cj-10-0918] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fulminant myocarditis involves various serious arrhythmias that sometimes have lethal consequences. The purpose of the present study was to investigate the electrocardiogram findings, arrhythmogenicity and abnormalities of the cardiac conduction system in children with fulminant myocarditis. METHODS AND RESULTS Between 1999 and 2008, 7 consecutive patients (mean age: 7 years) who suffered from fulminant myocarditis were included in the study. A 12-lead electrocardiogram, Holter monitoring and signal-averaged electrocardiograms were performed and compared between the acute, convalescent, and recovery phases in the 4 surviving patients. Also, electrophysiologic assessment was carried out during the convalescent phase. Five out of 7 patients developed complete atrioventricular block, 3 developed ventricular tachycardia, 2 had cardiac arrest, 2 developed sinus tachycardia, 1 developed ventricular fibrillation, 1 had advanced atrioventricular block, and 1 developed sick sinus syndrome. Among the surviving patients, all arrhythmias resolved during the convalescent and remote phases. No atrial or ventricular arrhythmias were induced in any patients during the programmed stimulation study. In the convalescent phase, no arrhythmias could be induced and there were no signs of any conduction abnormalities on electrophysiological assessment. CONCLUSIONS Close follow-up should be performed to observe for the occurrence of any new arrhythmias and/or a decrease in cardiac function in children with fulminant myocarditis.
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Affiliation(s)
- Rie Ichikawa
- Department of Pediatrics and Child Health, Nihon University, School of Medicine, Tokyo, Japan
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Di Bella G. Walking with Gianluca Di Bella during the development of clinical cardiac imaging. World J Cardiol 2010; 2:399-402. [PMID: 21179307 PMCID: PMC3006476 DOI: 10.4330/wjc.v2.i11.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/28/2010] [Accepted: 11/04/2010] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) for the diagnosis and management of many cardiac diseases has been established in clinical practice. It provides anatomic and functional information and is the most precise technique for quantification of ventricular volume, function and mass. Among cardiac MRI sequences used in clinical practice, delayed contrast enhancement is an accurate and reliable method used in the diagnosis of ischemic and nonischemic cardiomyopathies. In addition, new technology applied in echocardiographic imaging has permitted quantification of myocardial deformations with 2-dimensional strain imaging (longitudinal, circumferential and radial strain). Cardiac MRI and echocardiography therefore both play a crucial role in the diagnosis and management of cardiovascular disease. Dr. Di Bella and colleagues have defined the roles of cardiac MRI and echocardiography in many clinical and experimental settings.
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Affiliation(s)
- Gianluca Di Bella
- Gianluca Di Bella, Clinical and Experimental Department of Medicine and Pharmacology, Faculty of Medicine, University of Messina, CAP 98100, Messina, Italy
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Ukimura A, Izumi T, Matsumori A. A national survey on myocarditis associated with the 2009 influenza A (H1N1) pandemic in Japan. Circ J 2010; 74:2193-9. [PMID: 20697177 DOI: 10.1253/circj.cj-10-0452] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND An influenza pandemic occurred in 2009 and myocarditis associated with the 2009 influenza A (H1N1) pandemic was reported among hospitalized patients from August 2009. METHODS AND RESULTS The Japanese Circulation Society organized the Clinical Research Committee on Myocarditis Associated with Influenza Pandemic A (H1N1) 2009 and called for a case report on myocarditis for a national survey. The diagnosis of myocarditis was performed using the Guidelines for the Diagnosis and Treatment of Myocarditis (JCS 2009). Fifteen patients were reported to the committee. Fulminant myocarditis developed in 10 patients. Mechanical circulatory support (intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS)) was used on all 10 patients, 8 of whom were rescued. Abnormalities on echocardiography and elevated cardiac enzymes were seen in most of the patients. Myocarditis was found by endomyocardial biopsy in 6 patients. Three patients had complications with pneumonia. CONCLUSIONS In reality, myocarditis associated with pandemic influenza A (H1N1) seemed to be more common in hospitalized patients, compared with previous seasonal influenza virus outbreaks. To avoid misdiagnosis of acute myocarditis associated with influenza pandemic A (H1N1) 2009, it is essential to determine the characteristic symptoms, signs, and laboratory findings of acute myocarditis during influenza pandemics. Mechanical circulatory support (IABP and/or PCPS) was required to rescue patients with fulminant myocarditis.
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Affiliation(s)
- Akira Ukimura
- Department of General Internal Medicine, Osaka Medical College, Takatsuki, Japan.
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