The diagnostic value of speckle-tracking echocardiography in myocarditis and dilated cardiomyopathy

Abstract

The purpose of the investigation – to study the diagnostic opportunities of Speckle-Tracking Echocardiography (STE) in patients with Inflammatory Cardiomyopathy (ICM) and Dilated Cardiomyopathy (DCM). Materials and methods: We examined 27 patients: 14 – with ICM (1st group) and 13 – with DCM (2nd group), the average age was (36,1±3,2) and (37,6±2,8) years respectively. By the use of STE we studied the parameters of myocardial deformation, which were: the absolute values of Longitudinal Global Systolic Strain (LGSS), Circumferential Global Systolic Strain (CGSS), Radial Global Systolic Strain (RGSS), Velocity of LGSS (VLGSS), Velocity of CGSS (VCGSS) and Velocity of RGSS (VRGSS). In all patients were also performed the detection of serum antibody titers to the Myocardium (ATm) and the level of myocardium induced Blasttransformation Lymphocyte Activity (BTLAm). Both groups were comparable by the values of end systolic, end diastiolic volume, ejection fraction of the left ventricle (LV), which were measured by the use of 2D echocardiography and heart rate according to the ECG. Results: In the 1st group in comparison with the 2nd we detected the higher values of LGSS - (9,4±1,2) and (5,1±1,1) % (P<0,01), CGSS - (9,2±1,4) and (5,5±1,1) % (P<0,05), VCGSS - (0,65±0,08) and (0,42±0,06) s-1 (P<0,02) respectively. These findings provide the evidence of more pronounced impairment of LV contractile function in DCM than in ICM. The negative correlation was found in the 1st group between LGSS, CGSS, VCGSS and BTLAm - r=-0,47, (P<0,05); r=-0,37, (P<0,05); r=-0,38, (P<0,05) respectively and also between LGSS, CGSS, VLGSS and ATm titers - r=-0,42, (P<0,05); r=-0,57, (P<0,02); r=-0,41, (P<0,05) respectively. In the 2nd group we found correlation of STE parameters only with ATm titers, thus we observed the negative correlation between ATm titers and RGSS - r=-0,53, (P<0,02) as also with VRGSS r=-0,44, (P<0,05). These data may suggest the influence of both cellular and humoral autoimmune reactions on the impairment of the LV systolic function in ICM and only the humoral mechanisms in DCM that resulted in more pronounced myocardial damage associated with pathologic effects of ATm. Conclusion: The use of STE may be helpful for the assessment of LV contractile function in patients with inflammatory and dilated cardiomyopathy, we defined that DCM was characterized by more significant LV systolic dysfunction in comparison with ICM. We suggest the negative influence of both ATm and activated lymphocytes on the LV systolic function in ICM and only the antimyocardial antibodies in DCM.