Tünnemann-Tarr Adrienn, Stöbe Stephan, Laufs Ulrich, Hagendorff Andreas, Tayal Bhupendar
Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
J Cardiol Cases. 2020 Jul 7;22(4):184-191. doi: 10.1016/j.jccase.2020.06.011. eCollection 2020 Oct.
The present case of a patient with acute myocarditis with preserved left ventricular (LV) ejection fraction at the acute stage illustrates the obvious impairment of circumferential and rotational deformation, which can be documented by speckle tracking echocardiography. Thus, qualitative patterns of LV twist, radial strain, and circumferential layer strain, might be a new approach to detect acute myocarditis. The early diagnosis of acute myocarditis by echocardiography is important because of the considerable risk of cardiovascular morbidity as documented by the occurrence of an acute myocardial infarction presumably induced by inflammatory process in this case. <: The compound of myocardial deformations caused by left ventricular subendomyocardial and subepimyocardial fibers may be a crucial diagnostic target in cardiac diseases. The predominant involvement of viral myocarditis of the outer myocardial layers might induce impairment of circumferential and rotational deformation, which can potentially serve as a new diagnostic key by echocardiography. In contrast, left ventricular ejection fraction and longitudinal deformation are often observed within normal ranges in patients with acute myocarditis. Acute myocardial infarction as a major cardiac event in acute stage of myocarditis causes completely different deformation patterns, mainly by the predominant involvement of the inner myocardial layers inducing severe pathologies of territorial longitudinal deformation. Patients with suspected acute myocarditis and abnormal findings of circumferential and rotational deformation should undergo additional diagnostic procedures as cardiac magnetic resonance and myocardial biopsy to confirm the diagnosis.>.
本病例为一名急性期左心室（LV）射血分数保留的急性心肌炎患者，其圆周和旋转变形明显受损，这可通过斑点追踪超声心动图记录。因此，左心室扭转、径向应变和圆周层应变的定性模式可能是检测急性心肌炎的一种新方法。由于本病例中炎症过程可能诱发急性心肌梗死，从而导致心血管疾病的高风险，因此通过超声心动图早期诊断急性心肌炎很重要。<：由左心室心内膜下和心外膜下纤维引起的心肌变形复合可能是心脏疾病的关键诊断靶点。外层心肌的病毒性心肌炎的主要累及可能导致圆周和旋转变形受损，这有可能成为超声心动图的新诊断关键。相比之下，急性心肌炎患者的左心室射血分数和纵向变形通常在正常范围内。急性心肌梗死作为心肌炎急性期的主要心脏事件，会导致完全不同的变形模式，主要是由于内层心肌的主要累及导致局部纵向变形的严重病变。疑似急性心肌炎且圆周和旋转变形有异常发现的患者应接受额外的诊断程序，如心脏磁共振成像和心肌活检以确诊。>
