Predictive value of diastolic function assessed by CMR feature tracking in patients with suspected myocarditis and preserved left ventricular ejection fraction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Reduced left ventricular systolic function is a well established predictor for outcome in Patients with myocarditis. However, the predictive role of diastolic function in patients with suspected myocarditis and preserved ejection fraction is unknown. Purpose Assess the predicative value of diastolic left ventricular function in patients with suspected myocarditis. Methods Late and early radial, circumferential and longitudinal diastolic strain rate was assessed as using CMR feature tracking in patients with clinically suspected myocarditis being referred for cardiac magnetic resonance imaging (CMR). The primary endpoint was defined as a composite of first major adverse cardiovascular events (MACE) including all-cause mortality, sustained ventricular tachycardia and hospitalization for heart failure. Results 755 consecutive patients with suspected myocarditis and referred for CMR (277, 37% female; mean age 48 ± 16years) were included. Of those late gadolinium enhancement (LGE) was present in 417 (55.2%). 416 had a preserved ejection fraction >50% (55.1%). Mace was documented in 123 patients (16.3%) during a median observational time of 3.77 years. After adjustment for LVEF, LGE extend, age, and gender early circumferential strain rate (HR=0.35 95% CI 0.16–0.77, p = 0.009), early longitudinal diastolic strain rate (HR=0.40 95% CI 0.17–0.96, p = 0.042) and late diastolic strain rate (HR=0.23 95% CI 0.07–0.74, p = 0.013) remained independent predictors of MACE. Conclusion CMR feature tracking diastolic strain rate is independently associated with outcome, beyond LVEF and LGE in patients with myocarditis, and might therefore contribute to improved risk stratification in this sclinical setting.