Abstract 10971: Myocardial Edema in Acute Myocarditis Detected by Echocardiographic 2D Myocardial Deformation Analysis

Abstract

Introduction: The diagnosis of acute myocarditis is in daily practice based on symptoms, electrocardiography, elevated myocardial necrosis biomarkers, echocardiography and in selected cases supported by myocardial edema and fibrosis demonstrated by cardiovascular magnetic resonance (CMR). Often conventional echocardiography reveals no obvious changes in global function despite and therefore provides limited diagnostic value. Myocardial deformation imaging by echocardiography is an evolving method to quantitatively characterize myocardial function that may be influenced in acute myocarditis. Hypothesis: The aim of our study was to assess deformation imaging of the left ventricle in patients with CMR verified acute myocarditis. Methods: We included 28 consecutive patients (mean age 32±13 years) with CMR verified diagnosis of acute myocarditis by Lake Louise criteria. The cardiac function was evaluated by a comprehensive assessment of left ventricular (LV) function including 2D speckle tracking echocardiography. Results: We found no correlation between LV function assessed by echocardiographic ejection fraction and the amount of edema. However, we found wall motion score index to be significantly correlated to the amount of myocardial edema, however only observed, in patients with >11% edema of the LV. Global longitudinal systolic strain correlated significantly to the amount of edema (r= 0.65; p<0.001). We found that both the epicardial longitudinal- and endocardial longitudinal systolic strain significantly correlated to edema (r=0.55; p=0.003 and r=0.54; p=0.004). No significant correlation was observed analyzing circumferential strain (global: r=0.3; p=0.13; epicardial: r=0.26; p=0.19 and endocardial: r=0.32; p=0.1). However, we found the circumferential strain to be decreased in the infero-postero-lateral region. Conclusions: In patients with acute myocarditis we found 2D speckle tracking echocardiography to be a useful tools in the diagnostic process of acute myocarditis. Myocardial deformation imaging improved the diagnostic accuracy in acute myocarditis patients, especially when conventional echocardiographic parameters of LV are normal.