Utility of segmental and regional left ventricular longitudinal strain in identifying localization and extent of myocardial injury in patients with acute myocarditis confirmed by cardiac magnetic resonance

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Published Jun 1, 2025
https://doi.org/10.62438/tunismed.v103i6.5723
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Vol. 103 No. 6 (2025): Tunis Med June 2025

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Faten El Ayech Boudiche
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
https://orcid.org/0000-0002-1627-5426
Khaled Chalbi
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Selim Boudiche
Cardiology Department, La Rabta Hospital, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar,Tunisia.
Hakim Ben Jemaa
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Ahmed Chetoui
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia
Malek Elarbi
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia
Syrine Néji
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Habib Ben Ahmed
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Wejdene Ouechtati
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Emna Allouche
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.
Leila Bezdah
Cardiology Department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, university of Tunis El Manar ,Tunisia.

Abstract

Introduction-Aim: This study aimed to evaluate the role of echocardiographic left ventricular (LV) longitudinal strain (LS) in identifying the localization and extent of myocardial injury compared to edema and late gadolinium enhancement (LGE) detected on cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis (AM).


Methods: Patients >18years-old, with informed consent, and AM confirmed by CMR were prospectively enrolled between 1st November 2023 and 30th September 2024. Strain echocardiography with measurements of global (GLS) and segmental longitudinal strains (SLS) was performed. Number and localization of segments with impaired LS were compared with those with edema and/or LGE on CMR.


Results: 19 patients, 31.6±12.0 years old and 84.2% male were enrolled. Although LV ejection fraction (EF) was preserved in all patients, GLS was impaired in 63.2% of them. Impairment in regional LS was identified mainly in the anterolateral, inferolateral and inferior regions, in concordance with localization of edema and LGE detected by CMR, with strong correlation between extent of myocardial injury on CMR and number of segments with impaired SLS per patient (r=0.76; p=0.0002). Performance of SLS in the diagnosis of edema in AM patients was satisfactory with an AUC=0.725, CI 95% [0.67-0.78] and p<0.001. Cut-off value was -17.5% with a sensitivity of 71% and specificity of 65%.


Conclusion: In AM patients, analysis of LS identified impairment in LV myocardial deformation in patients with a normal LVEF. Comparison with CMR showed a very close topographical distribution between regions with impaired myocardial deformation and those ..(abstract truncated at 250 words).

Keywords:

strain echocardiography, segmental longitudinal strain, late gadolinium enhancement, myocardial edema

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