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Predictive Value of Left Ventricular Systolic Dysfunction or Wall Motion Abnormalities for Non-Ischemic Myocardial

Justyna M Sokolska1,2, Justyna Rajewska-Tabor3, Marek Koziński4,5

  • 1Department of Cardiovascular Imaging, Faculty of Medicine, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wrocław, Poland.

Journal of Clinical Medicine
|June 13, 2025
PubMed

Insights

Left ventricular systolic dysfunction, indicated by regional wall motion abnormalities or reduced ejection fraction, predicts non-ischemic myocardial injury in suspected myocarditis patients. These findings aid in diagnosing cardiac conditions using CMR imaging.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Myocardial Diseases

Background:

  • Left ventricular (LV) systolic dysfunction, encompassing reduced ejection fraction (LVEF) and regional wall motion abnormalities (RWMA), is crucial in cardiovascular disease assessment.
  • Myocarditis, an inflammation of the heart muscle, can lead to non-ischemic myocardial injury, characterized by fibrosis or scar tissue.
  • Assessing LV systolic dysfunction is vital for predicting myocardial damage in patients with suspected myocarditis.

Purpose of the Study:

  • To evaluate the predictive value of LV systolic dysfunction for non-ischemic myocardial injury in patients with suspected myocarditis.
  • To determine if parameters like LVEF and RWMA can identify myocardial fibrosis on cardiac magnetic resonance (CMR).
  • To establish imaging biomarkers for non-ischemic myocardial damage in this patient cohort.

Main Methods:

  • A multicenter, observational, retrospective study included 773 stable outpatients with suspected myocarditis from 2018-2021.
  • Contrast-enhanced CMR was used to assess LV systolic function (LVEF, RWMA) and late gadolinium enhancement (LGE) indicative of myocardial fibrosis.
  • Patients with prior cardiovascular disorders were excluded, focusing the analysis on suspected myocarditis.

Main Results:

  • Of 773 patients, 12% (95) had LV systolic dysfunction. Among 456 patients with confirmed non-ischemic LGE, 28% had RWMA and 18% had LVEF < 50%.
  • The median LGE involved 3 LV segments, constituting 6% of LV mass.
  • Wall motion score index > 1 (AUC 0.62) and LVEF < 56% (AUC 0.59) were significant predictors of non-ischemic myocardial injury.

Conclusions:

  • In stable patients with suspected myocarditis, the presence of any RWMA is a valuable predictor of non-ischemic myocardial injury.
  • An LVEF < 56% also demonstrated predictive value for myocardial fibrosis as assessed by CMR.
  • These LV systolic function parameters can aid in identifying myocardial damage in suspected myocarditis cases.

Keywords:
CMRLGEmyocardial injurysystolic dysfunctionwall motion abnormalities

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