5-key points

1. In patients with a preserved LVEF and acute myocarditis, global longitudinal strain is typically reduced (values of approximately -17%)
2. Global longitudinal systolic myocardial strain correlated significantly with the amount of edema
3. Segments with delayed enhancement on CMR show a significantly lower regional longitudinal strain in comparison with segments without.
4. Subepicardial GLS displays a better diagnostic performance to detect sequelae of acute myocarditis as compared with “normal” GLS
5. CMR-verified diagnosis of acute myocarditis according to the Lake Louise criteria remains the preferred imaging modality in diagnosing myocarditis. GLS seems to be of additional value and possibly a better follow up tool.

Cases

References

1. Caspar T, Fichot M, Ohana M, El Ghannudi S, Morel O, Ohlmann P. 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 Jun 6. pii: S0894-7317(17)30274-2.

2. 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 Jul;32(7):1093-101.

3. Løgstrup BB, Nielsen JM, Kim WY, Poulsen SH. Myocardial oedema in acute myocarditis detected by echocardiographic 2D myocardial deformation analysis. Eur Heart J Cardiovasc Imaging. 2016 Sep;17(9):1018-26.

4. Kasner M, Sinning D, Escher F, Lassner D, Kühl U, Schultheiss HP, Tschöpe C. The utility of speckle tracking imaging in the diagnostic of acute myocarditis, as proven by endomyocardial biopsy. Int J Cardiol. 2013 Oct 3;168(3):3023-4. doi: 10.1016/j.ijcard.2013.04.016. Epub 2013 May 20.

5. Escher F, Kasner M, Kühl U, Heymer J, Wilkenshoff U, Tschöpe C, Schultheiss HP. New echocardiographic findings correlate with intramyocardial inflammation inendomyocardial biopsies of patients with acute myocarditis and inflammatory cardiomyopathy. Mediators Inflamm. 2013;2013:875420.

6. Hsiao JF, Koshino Y, Bonnichsen CR, Yu Y, Miller FA Jr, Pellikka PA, Cooper LTJr, Villarraga HR. Speckle tracking echocardiography in acute myocarditis. Int J Cardiovasc Imaging. 2013 Feb;29(2):275-84.

7. Di Bella G, Gaeta M, Pingitore A, Oreto G, Zito C, Minutoli F, Anfuso C,Dattilo G, Lamari A, Coglitore S, Carerj S. Myocardial deformation in acute myocarditis with normal left ventricular wall motion–a cardiac magnetic resonance and 2-dimensional strain echocardiographic study. Circ J. 2010 Jun;74(6):1205-13.

8. Di Bella G, Coglitore S, Zimbalatti C, Minutoli F, Zito C, Patane’ S, Carerj S. Strain Doppler echocardiography can identify longitudinal myocardial dysfunction derived from edema in acute myocarditis. Int J Cardiol. 2008 May 23;126(2):279-80.