Key result
CMR-FT detects worse right ventricular strain in acute myocarditis with inferior and lateral injuries.
Why the study?
Evaluating right ventricular involvement in acute myocarditis remains challenging with standard 2D TTE and CMR.
Does CMR feature tracking detect subclinical right ventricular involvement in patients with acute myocarditis and preserved LV ejection fraction?
Observational (n=74)
No
Does CMR feature tracking detect subclinical right ventricular involvement in patients with acute myocarditis and preserved LV ejection fraction?
Absolute Event Rate: -21.2% vs -23.2%
p-value: p=0.201
CMR feature tracking can detect subclinical right ventricular involvement in acute myocarditis patients, particularly those with inferior and lateral left ventricular injuries.
May indicate subclinical LV dysfunction in preserved-EF myocarditis; leaves open GLS role in CMR diagnostics.
Background: Evaluation of the right ventricle (RV) in patients with acute myocarditis (MY) remains challenging with both 2D transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). We examined the incremental diagnostic value of CMR feature tracking (FT) to evaluate RV involvement in patients with myocarditis. Methods: We enrolled 54 patients with myocarditis and preserved left ventricle (LV) ejection fraction (EF). The CMR protocol included T2-weighted images for edema detection and late gadolinium enhancement (LGE) images. Global longitudinal strain (GLS) of the left ventricle (LV) and RV free wall strain (CMR-FWS) were obtained with CMR-FT. We identified 34 patients (62%) with inferior and lateral segment (IL-MY) involvement and 20 (38%) noIL-MY in case of any other myocardial segment involved. Here, 20 individuals who underwent CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as the control population. Results: TTE and CMR showed normal RV function in all patients without visible RV involvement at the LGE or T2-weighted sequences. At CMR, LV-GLS values were significantly lower in patients with MY compared to the control group (median −19.0% vs. −21.0%, p = 0.029). Overall, CMR RV-FWS was no different between MY patients and controls (median −21.2% vs. −23.2 %, p = 0.201) while a significant difference was found between RV FWS in IL-MY and noIL-MY (median −18.17% vs. −24.2%, p = 0.004). Conclusions: CMR-FT has the potential to unravel subclinical RV involvement in patients with acute myocarditis, specifically in those with inferior and lateral injuries that exhibit lower RV-FWS values. In this setting, RV deformation analysis at CMR may be effectively implemented for a comprehensive functional assessment.
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Bonanni et al. (2023) conducted an observational in Acute Myocarditis with Preserved Left Ventricular Ejection Fraction (n=74). Acute myocarditis vs. Asymptomatic controls was evaluated on Right ventricular free wall strain (RV-FWS) assessed by CMR-FT (p=0.201). While overall right ventricular free wall strain did not differ significantly from controls, CMR feature tracking detected significantly lower strain in acute myocarditis patients with inferior and lateral injuries (-18.17% vs -24.2%, p=0.004).
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