Myocarditis case 1
Patient with myocarditis. Severe global LV dysfunction in combination with troponin release following a clinical episode of upper tract respiratory infection.
LVEF of 20% due to global LV hypokinesia. See images below
Deformation imaging showed marked regional abnormalities with clear reduction of peak systolic strain in the apex (anteroseptal) and the posterolateral region midventricular. These regions also showed post systolic shortening. All other segments also show a reduced peak systolic strain value. The global longitudinal strain is severely impaired (-6.8%)
CMR showed patchy delayed enhancement in the LV. This was located midmyocardial and epicardial, a feature which is typically seen in myocarditis. The locations of these “patches” in the LV corresponded well to the sites of abnormal peak systolic strain by echocardiography: apical (anteroseptal) and posterolateral midventricular, see blue arrows below.
During follow up there was a complete restoration of the LVEF to 60%. However, deformation imaging still showed abnormal longitudinal strain in the regions of delayed enhancement on CMR, most likely due to irreversible damage at these areas (scar tissue)