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Incremental value of cardiac deformation analysis in acute myocarditis: a cardiovascular magnetic resonance imaging
Florian André1, Florian T Stock1, Johannes Riffel1
1Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Insights
Feature tracking imaging (FTI) applied to cardiovascular magnetic resonance (CMR) images reveals significantly impaired cardiac strain in acute myocarditis patients, even those with preserved ejection fraction (pEF). This strain assessment enhances diagnostic accuracy for myocarditis.
Area of Science:
- Cardiology
- Medical Imaging
- Biophysics
Background:
- Myocarditis, an inflammation of the heart muscle, can lead to significant cardiac dysfunction.
- Accurate assessment of cardiac deformation is crucial for diagnosing and managing myocarditis.
- Cardiovascular magnetic resonance (CMR) with feature tracking imaging (FTI) offers advanced methods for evaluating myocardial function.
Purpose of the Study:
- To evaluate cardiac deformation patterns in patients with acute myocarditis using FTI on CMR images.
- To determine if FTI-derived strain parameters can aid in the diagnosis of myocarditis, particularly in patients with preserved ejection fraction (pEF).
Main Methods:
- Cardiovascular magnetic resonance (CMR) imaging was performed on 36 patients with acute myocarditis and 36 healthy controls.
- Feature tracking imaging (FTI) was applied to standard cine CMR images to measure global peak circumferential, longitudinal, and radial systolic strains, as well as long axis strain (LAS).
- Late gadolinium enhancement (LGE) was assessed, and logistic regression models were used to evaluate the diagnostic performance of strain parameters combined with ejection fraction.
Main Results:
- Patients with acute myocarditis exhibited significantly impaired global peak circumferential, longitudinal, and radial systolic strains compared to controls.
- Even patients with preserved ejection fraction (pEF ≥55%) showed significantly reduced longitudinal and radial strains.
- The addition of global peak systolic strains to ejection fraction significantly improved the logistic regression model for differentiating patients from controls (AUC 0.98).
Conclusions:
- Cardiac strains measured by CMR-FTI are significantly impaired in patients with acute myocarditis, including those with pEF.
- FTI-derived strain assessment is a valuable tool that can improve the diagnostic accuracy of CMR for acute myocarditis.
- Strain analysis provides sensitive indicators of myocardial dysfunction in myocarditis, even when ejection fraction is preserved.
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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