Kasner Mario, Aleksandrov Aleksandar, Escher Felicitas, Al-Saadi Nidal, Makowski Markus, Spillmann Frank, Genger Martin, Schultheiss Heinz-Peter, Kühl Uwe, Pieske Burkert, Morris Daniel A, Noutsias Michel, Tschöpe Carsten
Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Department of Cardiology and Pulmonology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Clinic, Berlin, Germany.
Int J Cardiol. 2017 Sep 15;243:374-378. doi: 10.1016/j.ijcard.2017.05.038. Epub 2017 May 16.
Up to one third of patients with chronic myocarditis (MC) have preserved left ventricular (LV) ejection fraction (MCpEF). The purpose of this study was to evaluate the role of adding 2D speckle-tracking echocardiography (STE) to cardiac magnetic resonance imaging (cMRI) in the diagnosis of patients with MCpEF.
We analyzed 67 patients with suspected MCpEF who underwent endomyocardial biopsy (EMB). Thirty-two patients with confirmed chronic myocardial inflammation by EMB served as study group (MCpEF) and the remaining patients (n=35) served as control group. In all patients, 2D STE and cMRI were performed within 48h before EMB. Patients with MCpEF had significantly lower LV global longitudinal systolic strain (GLS) than controls (GLS: -17.01±2.42% vs. -19.39±3.81%, p<0.001; respectively). In line, an abnormal GLS had adequate diagnostic performance to detect MCpEF (sensitivity, specificity, and accuracy of 82%, 70%, and 76%, respectively), which was superior to cMRI based on the Lake-Louise criteria (sensitivity, specificity, and accuracy 54%, 71%, and 67%, respectively). In addition, adding GLS to the Lake-Louise criteria improved significantly the diagnostic performance of cMRI to detect MCpEF (sensitivity, specificity, and accuracy 96%, 55%, and 75%, respectively).
The findings of this study suggest that GLS using 2D STE could play an important role in the diagnostic evaluation of patients with suspected chronic myocarditis with preserved LV ejection fraction (MCpEF).
高达三分之一的慢性心肌炎（MC）患者左心室（LV）射血分数正常（MCpEF）。本研究的目的是评估二维斑点追踪超声心动图（STE）联合心脏磁共振成像（cMRI）在诊断MCpEF患者中的作用。
我们分析了67例疑似MCpEF并接受心内膜心肌活检（EMB）的患者。32例经EMB确诊为慢性心肌炎症的患者作为研究组（MCpEF），其余患者（n = 35）作为对照组。所有患者在EMB前48小时内进行了二维STE和cMRI检查。MCpEF患者的左心室整体纵向收缩应变（GLS）显著低于对照组（GLS：-17.01±2.42%对-19.39±3.81%，p<0.001）。同样，异常的GLS对检测MCpEF具有足够的诊断性能（敏感性、特异性和准确性分别为82%、70%和76%），优于基于路易斯湖标准的cMRI（敏感性、特异性和准确性分别为54%、71%和67%）。此外，将GLS纳入路易斯湖标准可显著提高cMRI检测MCpEF的诊断性能（敏感性、特异性和准确性分别为96%、55%和75%）。
本研究结果表明，使用二维STE的GLS在疑似左心室射血分数正常的慢性心肌炎（MCpEF）患者的诊断评估中可发挥重要作用。
