Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Center, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2022 Oct;50(7):485-491. doi: 10.5543/tkda.2022.22358.
Acute myocarditis mimics acute coronary syndrome due to its clinical course and presentation. This study aimed to evaluate left ventricular longitudinal and circumferential functions during the acute phase and late phase of acute myocarditis with preserved left ventricular ejection fraction using 2-dimensional speckle tracking echocardiography.
Forty-one consecutive acute myocarditis patients with preserved left ventricular ejection fraction confirmed by cardiac magnetic resonance imaging underwent 2-dimensional speckle tracking echocardiography within the first week of hospital admission. Findings were compared with age and sex-matched 40 healthy controls. Left ventricular mechanics of the study group were reevaluated by 2-dimensional speckle tracking echocardiography during follow- up (23.85 ± 6.65 months later).
Myocardial lesions with late gadolinium enhancement on cardiac magnetic resonance imaging were mostly localized in the subepicardial layer (91.40%) and commonly observed in the inferolateral wall (42.94%). Consistent with the cardiac magnetic resonance imaging findings, 2-dimensional speckle tracking echocardiography showed the localization of the involved myocardial segments with prominent impairment in global longitudinal peak systolic strain and global circumferential strain of the inferolateral wall of the left ventricle. In the acute phase, global longitudinal peak systolic strain (-17.32 ± 2.02 vs -20.59 ± 2.38) and global circumferential strain (-22.33 ± 2.27 vs -24.85 ± 3.19) were found to be lower in patients with acute myocarditis compared to healthy controls (both P < .001). While global circumferential strain was improved in the late phase compared with the acute phase (from -22.28 ± 2.32 to -22.90 ± 2.65; P = .003). Global longitudinal peak systolic strain was not significantly changed during follow-up (from -17.30 ± 2.09 to -17.62 ± 2.19; P = .072).
Subtle left ventricular systolic function impairment can be detected by the 2-dimensional speckle tracking echocardiography technique in patients with acute myocarditis with preserved left ventricular ejection fraction and improvement in circumferential function could be observed during follow-up.
由于其临床过程和表现，急性心肌炎类似于急性冠状动脉综合征。本研究旨在使用二维斑点追踪超声心动图评估左心室射血分数保留的急性心肌炎的急性期和晚期的左心室纵向和环向功能。
41 例经心脏磁共振成像证实的左心室射血分数保留的急性心肌炎连续患者在入院后第一周内接受二维斑点追踪超声心动图检查。将检查结果与年龄和性别匹配的 40 名健康对照者进行比较。在随访期间（23.85±6.65 个月后），通过二维斑点追踪超声心动图对研究组的左心室力学进行重新评估。
心脏磁共振成像上的晚期钆增强病变主要定位于心外膜下（91.40%），常见于下外侧壁（42.94%）。与心脏磁共振成像结果一致，二维斑点追踪超声心动图显示受累节段的定位，左心室下外侧壁的整体纵向峰值收缩应变和整体环向应变明显受损。在急性期，与健康对照组相比，急性心肌炎患者的整体纵向峰值收缩应变（-17.32±2.02 对-20.59±2.38）和整体环向应变（-22.33±2.27 对-24.85±3.19）均较低（均 P <.001）。而在晚期，整体环向应变较急性期改善（从-22.28±2.32 到-22.90±2.65；P =.003）。在随访期间，整体纵向峰值收缩应变无明显变化（从-17.30±2.09 到-17.62±2.19；P =.072）。
二维斑点追踪超声心动图技术可检测左心室射血分数保留的急性心肌炎患者的左心室收缩功能轻度受损，随访中可观察到环向功能改善。
