352 Impaired LV-GLS in Patients With Myocarditis as a Predictor of Recurrence of Chest Pain Requiring Hospitalisation

Abstract

Myocarditis is an inflammatory disorder characterized by myocardial inflammation leading to variable clinical outcomes, including recurrent chest pain, cardiac failure and death. In myocarditis patients, subclinical impairment of ventricular systolic function can be detected via sensitive echocardiographic measures such as left ventricular global longitudinal strain (LV-GLS) and right ventricular free wall strain (RV-FWS). The aim of our study was to evaluate the association of LV-GLS and RV-FWS in patients with myocarditis without associated clinical cardiac dysfunction with regards to recurrent hospitalisation for chest pain. Patients admitted to our institution with an established diagnosis of myocarditis (2013-2018) based on Dallas criteria and comprehensive transthoracic echocardiogram were included (n=64). Patients with pre-existent cardiac disease, impaired LVEF, RV-FAC, RVS’ and TAPSE were excluded (n=24). Strain analysis of LV and RV was performed using vendor-independent software (TomTec Arena, Germany v4.6). Patients were followed up post-discharge for recurrence of chest pain requiring hospitalisation. Forty patients (44.3±16.7yrs; 40% female) were included with a mean LV-GLS% of -16.4±2.9% and RV-FWS of -22.6±5.1%. On median follow-up of 24 months, recurrence of chest pain requiring hospitalisation occurred in 9 (22.5%) patients. There was an association between recurrence of chest pain requiring hospitalisation and impaired LV-GLS (p=0.026), but not with age (p=0.816), peak troponin level (p=0.873), LVEF (p=0.312), RV-FAC (p=0.464) or RV-FWS (p=0.709). LV-GLS may be a predictor for chest pain recurrence requiring hospitalisation in patients with myocarditis. Patients with impaired LV-GLS on presentation with acute-phase myocarditis may benefit from more aggressive medical therapy and follow-up.