Key result
Worsening CMR-derived LV GLS is linked to ~22% higher MACE risk per percent in acute myocarditis.
Why the study?
Patients with myocarditis are at high risk of major adverse cardiac events, and the prognostic value of atrial and ventricular strain derived from CMR for MACE has not been comprehensively evaluated.
Does CMR-derived atrial and ventricular strain predict major adverse cardiac events in patients with myocarditis?
Meta-Analysis (n=3,454)
Does CMR-derived atrial and ventricular strain predict major adverse cardiac events in patients with myocarditis?
Hazard Ratio: 1.22 (95% CI 1.13–1.31)
p-value: p=<0.05
CMR-derived left atrial and left ventricular strain parameters are significant independent predictors of major adverse cardiac events in patients with myocarditis, offering improved prognostic risk stratification beyond traditional LVEF and LGE.
CMR-derived LV global longitudinal strain may refine MACE risk stratification in acute myocarditis; leaves open incremental value in prospective cohorts.
Background: Myocarditis refers to an inflammatory response of myocardial tissue caused by various causes. Patients with myocarditis are at high risk of adverse prognosis, defined as major adverse cardiac events (MACEs). Atrial and ventricles strain analysis using cardiovascular magnetic resonance (CMR) plays a crucial role in the prognostic evaluation of myocarditis. This meta-analysis provides the first comprehensive evaluation of the predictive value of atrial and ventricular strain derived from CMR for MACE in patients with myocarditis. Methods: We searched PubMed, Embase, Web of Science, Cochrane Library, OVID Medline, Scopus, Sinomed, CNKI, Wanfang Data, VIP Database, and the search time range spans from the establishment of the database to June 2026. The level of evidence was assessed based on meta-analyses of the hazard ratios (HR) and 95% confidence intervals (CIs) of atrial and ventricular strain parameters for predicting MACE. Fixed-effect or random-effect models were used to synthesize data, with I 2 and sensitivity analyses for heterogeneity. Results: A total of 18 studies involving 3,454 participants were included, comprising 15 studies on left ventricular (LV) strain, 8 on right ventricular (RV) strain, and 8 on left atrial (LA) strain. Regarding LV myocardial strain, global longitudinal strain (GLS) (HR 1.22, 95% CI: 1.13–1.31), global circumferential strain (GCS) (HR 1.18, 95% CI: 1.10–1.28), and global radial strain (GRS) (HR 0.91, 95% CI: 0.86–0.95) all showed prognostic value for MACE in acute myocarditis. The timing of magnetic resonance (MR) examination is critical, and imaging appears to be most informative when performed within 2 weeks, or even within 1 week, after symptom onset. Regarding LA myocardial strain, Ԑs (HR 0.89, 95% CI: 0.83–0.96) and Ԑe (HR 0.92, 95% CI: 0.88–0.96) showed prognostic value for MACE in both acute and chronic myocarditis. In contrast, RV strain parameters showed limited prognostic value for MACE. Conclusions: LA and LV strain derived from CMR are associated with MACEs in patients with myocarditis. Incorporating myocardial strain into the management of myocarditis may improve risk stratification.
No takes yet. Share an insight, caveat, or question.
Li et al. (2026) conducted a meta-analysis in Myocarditis (n=3,454). Left ventricular global longitudinal strain (GLS) vs. 1% improvement in strain was evaluated on Major adverse cardiac events (MACE) (HR 1.22, 95% CI 1.13-1.31, p=<0.05). Each 1% worsening in left ventricular global longitudinal strain derived from CMR increased the risk of major adverse cardiac events by 22% (HR 1.22) in patients with acute myocarditis.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: