TY - JOUR
T1 - Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF
AU - Porcari, A.
AU - Merlo, M.
AU - Baggio, C.
AU - Gagno, G.
AU - Cittar, M.
AU - Barbati, G.
AU - Paldino, A.
AU - Castrichini, M.
AU - Vitrella, G.
AU - Pagnan, L.
AU - Cannata, A.
AU - Andreis, A.
AU - Cecere, A.
AU - Cipriani, A.
AU - Raafs, A.
AU - Bromage, D.I.
AU - Rosmini, S.
AU - Scott, P.
AU - Sado, D.
AU - Di Bella, G.
AU - Nucifora, G.
AU - Marra, M.P.
AU - Heymans, S.
AU - Imazio, M.
AU - Sinagra, G.
N1 - Funding Information:
We would like to thank Fondazione CRTrieste, Fondazione CariGO, Fincantieri and all the healthcare professionals for the continuous support to the clinical management of patients affected by cardiomyopathies, followed in Heart Failure Outpatient Clinic of Trieste, and their families.
Publisher Copyright:
© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
PY - 2022/10
Y1 - 2022/10
N2 - 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 Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 days from hospitalization. At 27 months, 24 (9%) patients experienced >= 1 ACE (71% developed LVEF <50%). Compared to the others, they had lower median LV-GLS values (-13.9% vs. -17.5%, p = .001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as > -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.
AB - 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 Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 days from hospitalization. At 27 months, 24 (9%) patients experienced >= 1 ACE (71% developed LVEF <50%). Compared to the others, they had lower median LV-GLS values (-13.9% vs. -17.5%, p = .001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as > -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.
KW - acute myocarditis
KW - cardiac magnetic resonance
KW - global longitudinal strain
KW - normal left ventricular ejection fraction
KW - prognostic stratification
KW - CARDIOVASCULAR MAGNETIC-RESONANCE
KW - REPRODUCIBILITY
KW - ASSOCIATION
KW - MANAGEMENT
KW - DIAGNOSIS
U2 - 10.1111/eci.13815
DO - 10.1111/eci.13815
M3 - Article
C2 - 35598175
SN - 0014-2972
VL - 52
JO - European Journal of Clinical Investigation
JF - European Journal of Clinical Investigation
IS - 10
M1 - e13815
ER -