Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy.
Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy.
Eur J Clin Invest. 2022 Oct;52(10):e13815. doi: 10.1111/eci.13815. Epub 2022 May 29.
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization. Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF.
Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized versus. non-localized, subepicardial versus midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%.
Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, they had lower median LV-GLS values (-13.9% vs. -17.5%, p = .001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as > -20% or quartiles), non-localized and midwall LGE were associated with ACEs. Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for non-localized and midwall LGE.
In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort.
对于射血分数正常的急性心肌炎（AM）患者，预后分层主要依赖于晚期钆增强（LGE）特征。通过特征追踪分析测量的左心室峰值整体纵向应变（LV-GLS）可能会改善射血分数正常的 AM 的预后。
回顾性分析了 7 个欧洲中心（2013-2020 年）因临床疑似 AM 而行心脏磁共振（CMR）的患者数据。纳入了经 CMR 证实且射血分数≥50%的 AM 患者。通过视觉特征对 LGE 进行了分类：局限性与非局限性、心外膜下与中层。使用专用软件测量 LV-GLS。主要终点是首次发生不良心血管事件（ACE），包括心源性死亡、危及生命的心律失常、心力衰竭或射血分数<50%的发生。
在 389 名筛查患者中，256 名（66%）符合纳入标准：年龄中位数 36 岁，71%为男性，射血分数中位数 60%，LV-GLS 中位数-17.3%。CMR 在住院后 4 天进行。在 27 个月时，24 名（9%）患者发生了≥1 次 ACE（71%发展为射血分数<50%）。与其他患者相比，他们的 LV-GLS 中位数较低（-13.9%比-17.5%，p=0.001）。在 Kaplan-Meier 分析中，LV-GLS 受损（均考虑为> -20%或四分位间距）、非局限性和中层 LGE 与 ACE 相关。LV-GLS≤-20%的患者未发生 ACE。在调整非局限性和中层 LGE 后，LV-GLS 仍然与 ACE 相关。
在射血分数≥50%的 AM 患者中，LV-GLS 提供了比 LGE 特征更独立的预后价值，改善了风险分层，并为该队列的进一步治疗研究提供了依据。
