Two-Dimensional Speckle-Tracking-Derived Segmental Peak Systolic Longitudinal Strain Identifies Regional Myocardial Involvement in Patients with Myocarditis and Normal Global Left Ventricular Systolic Function

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• 作者：Santosh C. Uppu ; Amee Shah ; Justin Weigand ; James C. Nielsen…
• 关键词：Acute myocarditis ; Speckle ; tracking echocardiography ; Cardiovascular magnetic resonance imaging
• 刊名：Pediatric Cardiology
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：36
• 期：5
• 页码：950-959
• 全文大小：1,081 KB
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  19.Marcus
• 作者单位：Santosh C. Uppu (1) (2)
  Amee Shah (1) (3)
  Justin Weigand (1)
  James C. Nielsen (1) (2) (4)
  H. Helen Ko (1)
  Ira A. Parness (1)
  Shubhika Srivastava (1)
  
  1. Division of Pediatric Cardiology, Mount Sinai School of Medicine, Box 1201, One Gustave L. Levy Place, New York, NY, 10029, USA
  2. Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
  3. Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, NY, USA
  4. Division of Pediatric Cardiology, Stony Brook Children’s, New York, NY, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

The presence of myocardial late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in concert with electrocardiography and elevated biomarkers helps support the diagnosis of acute myocarditis. Two-dimensional echocardiography is limited to global and qualitative regional function assessment and may not contribute to the diagnosis, especially in the presence of normal LV systolic function. Two-dimensional speckle-tracking (2D-STE)-derived segmental peak systolic (pkS) longitudinal strain (LS) may identify segmental myocardial involvement in myocarditis. We sought to identify an association between segmental pkS, LGE, and troponin levels in patients with myocarditis. Retrospective analysis of myocardial segmental function by 2D-STE segmental strain was compared to the presence of LGE and admission peak troponin levels in patients with acute myocarditis and preserved global LV systolic function. American Heart Association 17-segment model was used for comparison between imaging modalities. Global function was assessed by m-mode-derived shortening fraction (SF). Descriptive statistics and regression analysis were utilized. Forty-four CMRs performed to evaluate for myocarditis were identified. Of the 44, 10 patients, median age 17.5?years (14-8.5?years) and median SF 35?% (28-4?%), had paired CMR and 2D-STE data for analysis, and 161/170 segments could be analyzed by both methods for comparison. PkS LS was decreased in 51?% of segments that were positive for LGE with average pkS of ?4.7?%. Segmental pkS LS abnormalities were present in all but one patient who had abnormal pkS circumferential strain. Global pkS LS was decreased in patients with myocarditis. There is a moderate correlation between decreased pkS LS and the presence of LGE by CMR,?2D-STE for myocardial involvement in acute myocarditis can serve as an?useful noninvasive adjunct to the existing tests used for the diagnosis of acute myocarditis and might have a role in prognostication.