Key result
LV radial strain and diastolic circumferential strain rate predict major cardiovascular events in convalescent myocarditis with preserved LVEF.
Why the study?
The convalescent phase of myocarditis in patients with preserved left ventricular ejection fraction is poorly characterized, and persistent inflammation may increase MACE risk.
Does myocardial strain analysis using CMR predict major adverse cardiovascular events in adult patients with myocarditis and preserved left ventricular ejection fraction during the convalescent phase?
Cohort (n=146)
No
Does myocardial strain analysis using CMR predict major adverse cardiovascular events in adult patients with myocarditis and preserved left ventricular ejection fraction during the convalescent phase?
Left ventricular global radial strain and diastolic middle circumferential strain rate assessed by CMR provide independent prognostic value for predicting MACE in patients recovering from myocarditis with preserved ejection fraction.
Answers are grounded in this paper and cite their sources.
May support CMR strain for MACE risk stratification in preserved-EF myocarditis; hypothesis-generating and requires prospective validation.
Background The convalescent phase of myocarditis in patients with preserved left ventricular ejection fraction remains poorly characterized. Persistent myocardial inflammation may elevate the risk of major adverse cardiovascular events (MACE). Conventional assessment of left ventricular function is limited in sensitivity, whereas myocardial strain analysis provides detection of subclinical myocardial dysfunction. Methods In this retrospective study, 317 patients with myocarditis underwent cardiac magnetic resonance (CMR). Feature-tracking CMR was used to quantify ventricular and atrial strain parameters. Late gadolinium enhancement (LGE) was assessed for myocardial tissue characterization. Patients were followed clinically, with MACE as the primary endpoint. Results Among 146 patients included in the final analysis (71 male; mean age 26 ± 16 years), 36 experienced MACE. LGE was present in 54.8% of patients. In LGE positive patients, one, two, and three or more segments were involved in 6.25%, 16.25%, and 77.50% of cases, respectively. In univariable and multivariable Cox regression analyses, left ventricular global radial strain ( p = 0.026) and left ventricular diastolic middle circumferential strain rate ( p = 0.014) emerged as independent predictors of MACE. Conclusions Left ventricular global radial strain may reflect persistent myocardial inflammation during convalescence from myocarditis. Myocardial strain parameters provide incremental prognostic value beyond conventional functional measures.
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Huang et al. (2026) conducted a cohort in Myocarditis with preserved left ventricular ejection fraction (n=146). Left ventricular global radial strain was evaluated on Major adverse cardiovascular events (MACE) (HR 0.966, 95% CI 0.937-0.996, p=0.026). Left ventricular global radial strain and diastolic middle circumferential strain rate independently predicted major adverse cardiovascular events in convalescent myocarditis patients with preserved ejection fraction.
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