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Erschienen in: Pediatric Cardiology 5/2015

01.06.2015 | Original Article

Two-Dimensional Speckle-Tracking-Derived Segmental Peak Systolic Longitudinal Strain Identifies Regional Myocardial Involvement in Patients with Myocarditis and Normal Global Left Ventricular Systolic Function

verfasst von: Santosh C. Uppu, Amee Shah, Justin Weigand, James C. Nielsen, H. Helen Ko, Ira A. Parness, Shubhika Srivastava

Erschienen in: Pediatric Cardiology | Ausgabe 5/2015

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Abstract

The presence of myocardial late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in concert with electrocardiography and elevated biomarkers helps support the diagnosis of acute myocarditis. Two-dimensional echocardiography is limited to global and qualitative regional function assessment and may not contribute to the diagnosis, especially in the presence of normal LV systolic function. Two-dimensional speckle-tracking (2D-STE)-derived segmental peak systolic (pkS) longitudinal strain (LS) may identify segmental myocardial involvement in myocarditis. We sought to identify an association between segmental pkS, LGE, and troponin levels in patients with myocarditis. Retrospective analysis of myocardial segmental function by 2D-STE segmental strain was compared to the presence of LGE and admission peak troponin levels in patients with acute myocarditis and preserved global LV systolic function. American Heart Association 17-segment model was used for comparison between imaging modalities. Global function was assessed by m-mode-derived shortening fraction (SF). Descriptive statistics and regression analysis were utilized. Forty-four CMRs performed to evaluate for myocarditis were identified. Of the 44, 10 patients, median age 17.5 years (14–18.5 years) and median SF 35 % (28–44 %), had paired CMR and 2D-STE data for analysis, and 161/170 segments could be analyzed by both methods for comparison. PkS LS was decreased in 51 % of segments that were positive for LGE with average pkS of −14.7 %. Segmental pkS LS abnormalities were present in all but one patient who had abnormal pkS circumferential strain. Global pkS LS was decreased in patients with myocarditis. There is a moderate correlation between decreased pkS LS and the presence of LGE by CMR, 2D-STE for myocardial involvement in acute myocarditis can serve as an useful noninvasive adjunct to the existing tests used for the diagnosis of acute myocarditis and might have a role in prognostication.
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Metadaten
Titel
Two-Dimensional Speckle-Tracking-Derived Segmental Peak Systolic Longitudinal Strain Identifies Regional Myocardial Involvement in Patients with Myocarditis and Normal Global Left Ventricular Systolic Function
verfasst von
Santosh C. Uppu
Amee Shah
Justin Weigand
James C. Nielsen
H. Helen Ko
Ira A. Parness
Shubhika Srivastava
Publikationsdatum
01.06.2015
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 5/2015
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-015-1105-9

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