The association of inflammatory response with speckled global strain in recovered patients with myocarditis

This study aimed to investigate the relationship between simple, routinely available inflammatory markers and residual impairment of left ventricular (LV) function assessed by 2D global longitudinal strain (GLS) in patients recovered from myocarditis.

This prospective study included patients diagnosed with Myocarditis who were followed in our heart failure clinic. All participants underwent conventional echocardiography and 2D strain analysis at follow-up. Echocardiographic data was compared with age and sex-matched healthy controls. The study group's bloodwork was analyzed for inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), at defined time intervals starting from admission.

A total of 104 myocarditis patients [22 women, mean age 30.9 ± 8.5 years, baseline LV ejection fraction (LVEF) 56.8 ± 6.8%] were included. At a median follow-up of 78.4 months (IQR: 53.5-99.2), median GLS remained significantly less negative compared with healthy controls [-18.0% (IQR: -18.8 to -17.5) vs -21.4% (IQR: -22.7 to -19.4); P < 0.001]. At presentation, patients showed elevated inflammatory markers (WBC 10.7 ± 3.4 K/µL, NLR 5.53 ± 3.54, C-reactive protein 81.1 ± 67.7 mg/L), with WBC and NLR demonstrating an initial increase followed by significant decline at 72 hours and 6 months (P < 0.001). Regression analyses confirmed impaired GLS in myocarditis patients compared to controls (crude β = 2.88, 95% CI: 2.21-3.55; adjusted β = 2.54, 95% CI: 1.63-3.44; P < 0.001). Within the myocarditis cohort, admission NLR was independently associated with impaired GLS at follow-up (crude β = 0.190, 95% CI: 0.103-0.277; adjusted β = 0.170, 95% CI: 0.088-0.267; P < 0.001). Sex-stratified analysis showed significance in males (β = 0.179, 95% CI: 0.088-0.270; P < 0.001; R² = 0.163) but not in females (β = 0.194, 95% CI: -0.107 to 0.496; P = 0.194; R² = 0.083).

Elevated inflammatory markers at presentation, particularly NLR, were associated with impaired GLS at follow-up, independent of baseline demographic and clinical covariates. The predictive value of NLR appeared more evident in males, though limited female representation precludes firm sex-specific conclusions. NLR may serve as a simple, cost-effective marker for identifying patients at risk of residual subclinical LV dysfunction after myocarditis, but larger, sex-balanced cohorts are required to confirm these findings.