The Value of Two-dimensional Strain in the Diagnosis of Acute Myocarditis: Comparison with Cardiac Magnetic Resonance Imaging

Abstract

Introduction

Acute myocarditis is a major cause of sudden death in young patients. Cardiac magnetic resonance imaging (CMR) is a sensitive noninvasive method to detect myocarditis, but it is costly and unavailable in most medical centers. Two-dimensional strain is a new echocardiographic technique that evaluates myocardial strain to analyze global and regional myocardial function.

Objetive

To assess the value of two-dimensional strain in patients diagnosed with myocarditis.

Material and methods

We prospectively studied patients with acute myocarditis and normal cardiac contractility using CMR, who underwent conventional echocardiography and two-dimensional strain. The ventricular myocardium was divided into 16 segments and these segments were divided into two groups. Group 0: normal myocardial segment by CMR. Group 1: myocardial segment compatible with myocarditis using CMR.

Results

The study evaluated 28 patients, including 82,1% (n = 46) males with a mean age of 35.6 ± 8.9 years. Of the 448 myocardial segments evaluated, 316 segments were normal (group 0) and 132 segments (group 1) were diagnosed with myocarditis using the late enhancement technique on CMR. The analysis of two-dimensional strain showed a significant difference between the groups (19.6 ± 2.9 versus 15.4 ± 2.8 p = 0.001), with 75% sensitivity and 79% specificity and AUC of 0.86 (95% CI 0.82 to 0.89).

Conclusion

Two-dimensional strain can be useful in the evaluation of patients with myocarditis, normal contractility by CMR and conventional echocardiography. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(1):3-7)