Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute Myocarditis

Area of Science:

• Cardiovascular Imaging
• Radiology
• Cardiac MRI

Background:

• Acute myocarditis diagnosis can be challenging.
• Cardiac MRI feature-tracking (FT) strain analysis offers quantitative assessment of myocardial function.
• Layer-specific strain analysis may provide more precise diagnostic information.

Purpose of the Study:

• To evaluate the diagnostic performance of layer-specific cardiac MRI feature-tracking (FT) strain analysis in patients with acute myocarditis.
• To compare the diagnostic utility of different myocardial layers for strain analysis.
• To assess the added value of FT strain parameters to the 2018 Lake Louise criteria (LLC).

Main Methods:

• Retrospective analysis of 70 patients with acute myocarditis and 42 healthy controls.
• Cardiac MRI with assessment of left ventricular peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS) at subendocardial, midmyocardial, and subepicardial layers.
• Statistical analysis included unpaired t test, ANOVA, Pearson correlation, and ROC analysis.

Main Results:

• All myocardial layers showed impaired GLS and GCS in myocarditis patients compared to controls.
• Midmyocardial GCS and subepicardial GLS demonstrated the highest diagnostic performance for acute myocarditis (AUC, 0.82 and 0.77, respectively).
• Inclusion of these strain parameters significantly improved the diagnostic performance of the 2018 LLC (AUC, 0.97).

Conclusions:

• Layer-specific cardiac MRI FT strain analysis is valuable for diagnosing acute myocarditis.
• Midmyocardial GCS and subepicardial GLS are the most effective strain parameters for diagnosis.
• Combining FT strain parameters with the 2018 LLC enhances diagnostic accuracy.