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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
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Left Atrial Stiffness Identifies Children with Magnetic-Resonance-Imaging-Proven Acute Myocarditis Despite Preserved
Ryusuke Numata1, Renzo Calderon-Anyosa2, Danish Vaiyani3
1Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA. k054eb@gmail.com.
Pediatric Cardiology
|November 6, 2025
Summary
Left atrial (LA) stiffness is elevated in children with acute myocarditis and preserved ejection fraction, indicating diastolic dysfunction. This novel marker shows high diagnostic accuracy for pediatric myocarditis.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Biophysics
Background:
- The left atrium (LA) is often overlooked in pediatric myocarditis evaluations.
- LA stiffness has previously shown potential in identifying diastolic dysfunction and myocardial injury in children with COVID-19.
Purpose of the Study:
- To investigate if LA stiffness is abnormal in children diagnosed with acute myocarditis who have preserved ejection fraction.
- To assess the diagnostic utility of LA stiffness in this pediatric population.
Main Methods:
- Retrospective analysis of 51 pediatric patients with acute myocarditis (diagnosed via cardiac MRI) and 40 healthy controls.
- Inclusion criteria: preserved left ventricular ejection fraction (LVEF > 55%).
- Echocardiography (2D and speckle-tracking) assessed LV function and LA strain; LA stiffness calculated as E/e' to peak LA strain ratio.
Main Results:
- LA stiffness was significantly increased in myocarditis patients compared to controls (0.27 ± 0.09 vs. 0.15 ± 0.04 %⁻¹, p < 0.001) and remained elevated at follow-up.
- LA stiffness demonstrated the strongest correlation with peak B-type natriuretic peptide (BNP) levels (r = 0.66, p < 0.001).
- LA stiffness achieved the highest diagnostic performance (AUC 0.94) among echocardiographic indices and was an independent predictor (OR 1.58). A composite score with LV peak longitudinal strain yielded an AUC of 0.98.
Conclusions:
- Elevated LA stiffness is a significant finding in pediatric acute myocarditis with preserved LVEF, reflecting diastolic impairment.
- LA stiffness serves as a valuable, independent diagnostic marker for acute myocarditis in children, with a cutoff of 0.20 %⁻¹ offering incremental diagnostic value.
Keywords:
Left atrial stiffnessPediatricTwo-dimensional speckle-tracking echocardiographyVirus-related myocarditisMore Related Videos
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