Soeiro Alexandre M, Bossa Aline S, César Maria C, Leal Tatiana C A T, Garcia Guilherme, Fonseca Rafael A, Nakamura Débora, Guimarães Patrícia O, Soeiro Maria C F A, Serrano Carlos V, Soares Paulo R, Mueller Christian, Mebazaa Alexandre, Fernandes Fábio, Nomura Cesar H, Rochitte Carlos E, de Oliveira Múcio T
Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Front Cardiovasc Med. 2023 Jul 31;10:1121083. doi: 10.3389/fcvm.2023.1121083. eCollection 2023.
The role of myocardial strain in risk prediction for acute myocarditis (AMC) patients, measured by cardiac magnetic resonance (CMR), deserves further investigation. Our objective was to evaluate the association between myocardial strain measured by CMR and clinical events in AMC patients.
This was a prospective single-center study of patients with AMC. We included 100 patients with AMC with CMR confirmation. The primary outcome was the composite of all-cause mortality, heart failure and AMC recurrence in 24 months. A subgroup analysis was performed on a sample of 36 patients who underwent a second CMR between 6 and 18 months. The association between strain measures and clinical events or an increase in left ventricular ejection fraction (LVEF) was explored using Cox regression analysis. Global peak radial, circumferential and longitudinal strain in the left and right ventricles was assessed. ROC curve analysis was performed to identify cutoff points for clinical event prediction.
The mean follow-up was 18.7 ± 2.3 months, and the composite primary outcome occurred in 26 patients. The median LVEF at CMR at baseline was 57.5% (14.6%). LV radial strain (HR = 0.918, 95% CI: 0.858-0.982, = 0.012), LV circumferential strain (HR = 1.177, 95% CI: 1.046-1.325, = 0.007) and LV longitudinal strain (HR = 1.173, 95% CI: 1.031-1.334, = 0.015) were independently associated with clinical event occurrence. The areas under the ROC curve for clinical event prediction were 0.80, 0.79 and 0.80 for LV radial, circumferential, and longitudinal strain, respectively. LV longitudinal strain was independently correlated with prognosis (HR = 1.282, CI 95%: 1.022-1.524, = 0.007), even when analyzed together with ejection fraction and delayed enhancement. LV and right ventricle (RV) strain were not associated with an increase in LVEF. Finally, when the initial CMR findings were compared with the follow-up CMR findings, improvements in the measures of LV and RV myocardial strain were observed.
Measurement of myocardial strain by CMR can provide prognostic information on AMC patients. LV radial, circumferential and longitudinal strain were associated with long-term clinical events in these patients.
通过心脏磁共振成像（CMR）测量的心肌应变在急性心肌炎（AMC）患者风险预测中的作用值得进一步研究。我们的目的是评估通过CMR测量的心肌应变与AMC患者临床事件之间的关联。
这是一项针对AMC患者的前瞻性单中心研究。我们纳入了100例经CMR确诊的AMC患者。主要结局是24个月内全因死亡率、心力衰竭和AMC复发的综合情况。对36例在6至18个月期间接受第二次CMR检查的患者样本进行了亚组分析。使用Cox回归分析探讨应变测量值与临床事件或左心室射血分数（LVEF）增加之间的关联。评估了左、右心室的整体峰值径向、圆周和纵向应变。进行ROC曲线分析以确定临床事件预测的截断点。
平均随访时间为18.7±2.3个月，26例患者发生了综合主要结局。基线时CMR检查时的LVEF中位数为57.5%（14.6%）。左心室径向应变（HR = 0.918，95%CI：0.858 - 0.982，P = 0.012）、左心室圆周应变（HR = 1.177，95%CI：1.046 - 1.325，P = 0.007）和左心室纵向应变（HR = 1.173，95%CI：1.031 - 1.334，P = 0.015）与临床事件发生独立相关。左心室径向、圆周和纵向应变用于临床事件预测的ROC曲线下面积分别为0.80、0.79和0.80。即使与射血分数和延迟强化一起分析，左心室纵向应变仍与预后独立相关（HR = 1.282，95%CI：1.022 - 1.524，P = 0.007）。左心室和右心室（RV）应变与LVEF增加无关。最后，当将初始CMR结果与随访CMR结果进行比较时，观察到左心室和右心室心肌应变测量值有所改善。
通过CMR测量心肌应变可为AMC患者提供预后信息。左心室径向、圆周和纵向应变与这些患者的长期临床事件相关。
