In patients with acute myocarditis and normal LVEF, impaired left ventricular global longitudinal strain was independently associated with an increased risk of adverse cardiovascular events (HR 1.375 per unit increase).
Cohort (n=256)
Blinded image analysis
Yes
Does LV-GLS measured by CMR improve prognostic stratification over LGE characterization in patients with acute myocarditis presenting with normal LVEF?
In acute myocarditis with normal LVEF, LV-GLS measured by CMR provides independent prognostic value over LGE characterization for predicting adverse cardiovascular events.
Effect estimate: HR 1.375 (95% CI 1.210-1.552)
p-value: p=<0.001
BACKGROUND: Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization. Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF. METHODS: Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized versus. non-localized, subepicardial versus midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF -20% or quartiles), non-localized and midwall LGE were associated with ACEs. Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for non-localized and midwall LGE. CONCLUSION: In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort.
Porcari et al. (Sun,) conducted a cohort in Acute myocarditis with normal LVEF (n=256). CMR-FT Left Ventricular Global Longitudinal Strain (LV-GLS) vs. Standard of care (LGE characterization) was evaluated on First occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50% (HR 1.375, 95% CI 1.210-1.552, p=<0.001). In patients with acute myocarditis and normal LVEF, impaired left ventricular global longitudinal strain was independently associated with an increased risk of adverse cardiovascular events (HR 1.375 per unit increase).