Speckle-tracking parameters as predictors of left ventricular systolic dysfunction in patients with myocarditis

Authors

  • S. V. Сherniuk State Institution National Scientific Centre “Institute of Cardiology named after academician M.D. Strazhesko” of NAMS of Ukraine, Kyiv,

DOI:

https://doi.org/10.14739/2310-1210.2018.4.135543

Keywords:

myocarditis, prognosis, echocardiography

Abstract

Purpose. To evaluate the prognostic capabilities of speckle-tracking echocardiography for prediction of left ventricular systolic dysfunction persistence after 1-year follow-up of patients with myocarditis.

Methods. We included 58 patients with acute diffuse myocarditis and left ventricular (LV) systolic dysfunction – LV ejection fraction (EF) ≤40 % who underwent examination 3 times: within the 1st month after the disease onset, at 6- and 12-month follow-up. Transthoracic 2-dimensional echocardiography (EchoCG) and speckle-tracking echocardiography (STE) were performed with the measurement ofLV end-diastolic volume index (LV EDVi) and LV EF, longitudinal global systolic strain (LGSS) and strain rate (LGSSr), circumferential global systolic strain (CGSS) and strain rate (CGSSr), radial global systolic strain (RGSS) and strain rate (RGSSr). For better clarity, parameters of longitudinal and circumferential strain were presented in absolute values.

Results. After 12-month follow-up in comparison with the 1st month we observed improvement of LV EF 43.2 ± 3.1 % vs. 32.2 ± 2.7 % (P < 0.02), respectively, and decrease of LV EDVi 91.1 ± 6.6 ml/m2 vs. 112.2 ± 7.2 ml/m2 (P < 0.05), respectively. But statistically significant increase of STE parameters in comparison with their values in the 1st month was indicated after only 6-month follow-up: the absolute value of LGSS increased from 5.40 ± 0.41 % to 8.40 ± 0.63 % (P < 0.01) and the absolute value of CGSS – from 6.60 ± 0.73 to 10.40 ± 0.90 % (P < 0.01). By the 12th month there was a further increase in the absolute values of these indicators which corresponded to the statistically significant increase in LV EF and reduction in LV EDVi. By the use of binary regression analysis we defined cut-off values for STE parameters, measured within the 1st month of myocarditis onset, that with high sensitivity and specificity could predict LV systolic dysfunction persistence after 12 months: LGSS <8.6 %, LGSSr <0.61 s-1 and CGSS <8.3 %.

Conclusions. On the basis of dynamic observation we detected STE parameters that within the 1st month of myocarditis onset could be used for prognostication of LV systolic dysfunction persistence after 1-year follow-up: absolute values of LGSS <8.6 %, LGSSr <0.61 s-1 and CGSS <8.3 %.

 

References

Elamm, C., Fairweather, D. L., & Cooper, L. T. (2012). Pathogenesis and diagnosis of myocarditis. Heart, 98(4), 835–840.

Blessberger, H., & Binder, T. (2010). Two dimensional speckle-tracking echocardiography: clinical applications. Heart, 96(2), 2032–2040. doi: 10.1136/hrt.2010.199885.

Biestroek, P. S., Beek, A. M., Germans, T., Niessen, H., & Van Rossum, A. (2015) Diagnosis of myocarditis: current state and future perspectives. Int. J. Cardiol., 191, 211–9. doi: 10.1016/j.ijcard.2015.05.008.

Shauer, F., Gotsman, I., Keren, A., Zwas, D. R., Hellman, Y., Durst, R., & Admon, D. (2013). Acute viral myocarditis: current concepts in diagnosis and treatment. J. Isr. Med. Assoc., 15, 180–185.

Fung, G., Luo, H., Qin, Y., Yang, D., & McManus, B. (2016). Myocarditis. Circ. Res., 118(3), 496–514.

Hsiao, J. F., Koshino, Y., Bonninchsen, C. R., Yu, Y., Miller, F. A., Pellica, P. A., et al. (2013). Speckle tracking echocardiography in acute myocarditis. Int. J. Cardiovasc. Imag., 29(2), 275–284. doi: 10.1007/s10554-012-0085-6.

Caforio, A. L. P., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., et al. (2013). Current state of knowledge on aetiology, diagnosis, management and therapy of myocarditis: a position statement of the ESC Working group on myocardial and pericardial diseases. Eur. Heart J., 34(33), 2636–48, 2648a–2648d. doi: 10.1093/eurheartj/eht210.

Friedrich, M. G., Sechtem, U., Schulz-Menger, J., Holmvang, G., Alakija, P., Cooper, L. T., et al. (2009) Cardiovascular magnetic resonance in myocarditis: a Journal of the American College of Cardiology White Paper. J. Am. Coll. Cardiol., 53(17), 1475–1487. doi: 10.1016/j.jacc.2009.02.007.

McMurray, J. V., Adamopoulos, S., Anker, S. D., et al. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J., 33, 1787–1847.

Lang, R., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015). Recommendations for cardiac chamber quantification in adults: an update from the American Society of echocardiography and European Asssociation of cardiovascular imaging. J. Am. Soc. Echocardiogr., 28(1), 1–39.e14. doi: 10.1016/j.echo.2014.10.003.

Mornos, C., Rasinara, D., Manolis, A. J., Zacharopoulou, I., Pittaras, A., & Ionac, A. et al. (2011). The value of new speckle-tracking index including left ventricular global longitudinal strain and torsion in patients with dilated cardiomyopathy. Hallenic J. Cardiol., 52(4), 299–306.

Di Beela, G., Coglitore, S., Zimbulatti, C., Minutoli, F., Zito, C., Patane', S., & Carerj, S. (2008). Strain Doppler echocardiography can identify longitudinal myocardial dysfunction derived from edema in acute myocarditis. Int. J. Cardiol., 126(2), 279–280. doi: 10.1016/j.ijcard.2007.01.110.

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1.
Сherniuk SV. Speckle-tracking parameters as predictors of left ventricular systolic dysfunction in patients with myocarditis. Zaporozhye medical journal [Internet]. 2018Jul.13 [cited 2024Apr.18];(4). Available from: http://zmj.zsmu.edu.ua/article/view/135543

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Original research