The Diagnostic Role of Echocardiographic Strain Analysis in Patients Presenting with Chest Pain and Elevated
Jenna Schauer1, Elizabeth Caris1, Brian Soriano1
1Seattle Children's Hospital, University of Washington Medical Center, Seattle, Washington.
Insights
Myopericarditis in children, presenting as chest pain with elevated troponins, shows abnormal global longitudinal strain (GLS) on echocardiography. This strain abnormality persists even when other cardiac function measures normalize, aiding diagnosis.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Myocardial Diseases
Background:
- Myocarditis, or myopericarditis, is rare in healthy children presenting with chest pain and elevated troponins.
- Diagnosis is challenging due to normal conventional echocardiographic systolic function measures.
- Strain imaging may offer diagnostic utility in these cases.
Purpose of the Study:
- To evaluate the diagnostic value of echocardiographic strain imaging.
- To assess strain parameters in children with myopericarditis and elevated troponins.
- To compare strain findings with conventional echocardiography and cardiac MRI.
Main Methods:
- Multicenter retrospective study comparing 108 patients (group 1) with 19 controls (group 2).
- Patients underwent echocardiography and cardiac MRI within 30 days.
- Echocardiography-derived global longitudinal strain (GLS) was measured and compared between groups and subgroups.
Main Results:
- Patients with myopericarditis (group 1) had significantly lower ejection fraction and fractional shortening than controls (group 2).
- Peak global longitudinal strain (GLS) was markedly abnormal in group 1 compared to group 2.
- Abnormal GLS persisted at follow-up, even after ejection fraction and fractional shortening normalized.
Conclusions:
- Echocardiographic GLS is significantly impaired in pediatric myopericarditis with elevated troponins, despite normal conventional systolic function.
- Strain imaging provides valuable diagnostic information in these cases.
- GLS abnormalities are persistent, indicating potential long-term myocardial impact.
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. The aim of this study was to demonstrate the diagnostic utility of strain imaging in this scenario.
Methods:
This was a multicenter, retrospective study including patients presenting with chest pain and elevated troponin from 10 institutions who underwent cardiac magnetic resonance imaging and transthoracic echocardiography within 30 days of each other (group 1). Findings were compared with those among 19 control subjects (group 2). Clinical data and conventional echocardiographic and cardiac magnetic resonance imaging data were collected. Echocardiography-derived strain was measured at the core laboratory. Group 1 was divided into subgroups as myocarditis positive (group 1a) or negative (group 1b) on cardiac magnetic resonance imaging on the basis of established criteria.
Results:
Group 1 included 108 subjects (88 in group 1a, 20 in group 1b). Although all groups had normal mean fractional shortening and mean left ventricular ejection fraction, group 1 had significantly lower ejection fraction (56.8 ± 7.0%) compared with group 2 (62.3 ± 4.9%; P < .005) and fractional shortening (31.2 ± 4.9%) compared with group 2 (34.1 ± 3.5%; P < .05). Additionally, peak global longitudinal strain (GLS) was markedly abnormal in group 1 (-13.9 ± 3.4%) compared with group 2 (-19.8 ± 2.1%; P < .001). In subgroup analysis, GLS was markedly abnormal in group 1a (-13.2 ± 3.0%) compared with group 1b (-17.3 ± 2.6%; P < .001). Fifty-four subjects underwent follow-up echocardiography (46 in group 1a, eight in group 1b), with mean a follow-up time of 10 ± 11 months. At follow-up, whereas ejection fraction and fractional shortening returned to normal in all patients, abnormalities in strain persisted in group 1, with 22% still having abnormal GLS. Moreover, mean GLS was more abnormal in group 1a (-16.1 ± 2.6%) compared with group 1b (-17.4 ± 1.2%; P < .05).
Conclusions:
The present study demonstrates that echocardiographic GLS is significantly worse in subjects with myopericarditis presenting with chest pain and elevated troponins compared with control subjects even when conventional measures of systolic function are largely normal and that these abnormalities persisted over time.
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