Cau Riccardo, Pisu Francesco, Suri Jasjit S, Pontone Gianluca, D'Angelo Tommaso, Zha Yunfei, Salgado Rodrigo, Saba Luca
Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato, 09045 Cagliari, Italy.
Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA.
J Clin Med. 2024 Jan 23;13(3):662. doi: 10.3390/jcm13030662.
(1) : Myocarditis can be associated with ventricular arrhythmia (VA), individual non-invasive risk stratification through cardiovascular magnetic resonance (CMR) is of great clinical significance. Our study aimed to explore whether left atrial (LA) and left ventricle (LV) myocardial strain serve as independent predictors of VA in patients with myocarditis. (2) This retrospective study evaluated CMR scans in 141 consecutive patients diagnosed with myocarditis based on the updated Lake Louise criteria (29 females, mean age 41 ± 20). The primary endpoint was VA; this encompassed ventricular fibrillation, sustained ventricular tachycardia, nonsustained ventricular tachycardia, and frequent premature ventricular complexes. LA and LV strain function were performed on conventional cine SSFP sequences. (3) After a median follow-up time of 23 months (interquartile range (18-30)), 17 patients with acute myocarditis reached the primary endpoint. In the multivariable Cox regression analysis, LA reservoir (hazard ratio [HR] and 95% confidence interval [CI]: 0.93 [0.87-0.99], = 0.02), LA booster (0.87 95% CI [0.76-0.99], = 0.04), LV global longitudinal (1.26 95% CI [1.02-1.55], = 0.03), circumferential (1.37 95% CI [1.08-1.73], = 0.008), and radial strain (0.89 95% CI [0.80-0.98], = 0.01) were all independent determinants of VA. Patients with LV global circumferential strain > -13.3% exhibited worse event-free survival compared to those with values ≤ -13.3% ( < 0.0001). (4) LA and LV strain mechanism on CMR are independently associated with VA events in patients with myocarditis, independent to LV ejection fraction, and late gadolinium enhancement location. Incorporating myocardial strain parameters into the management of myocarditis may improve risk stratification.
(1)：心肌炎可能与室性心律失常（VA）相关，通过心血管磁共振（CMR）进行个体非侵入性风险分层具有重要的临床意义。我们的研究旨在探讨左心房（LA）和左心室（LV）心肌应变是否可作为心肌炎患者VA的独立预测指标。(2) 这项回顾性研究评估了141例根据更新的路易斯湖标准确诊为心肌炎的连续患者的CMR扫描结果（29例女性，平均年龄41±20岁）。主要终点是VA；这包括心室颤动、持续性室性心动过速、非持续性室性心动过速和频发室性早搏。在传统的电影稳态自由进动序列上进行LA和LV应变功能检查。(3) 在中位随访时间23个月（四分位间距[18 - 30]）后，17例急性心肌炎患者达到主要终点。在多变量Cox回归分析中，LA储备（风险比[HR]和95%置信区间[CI]：0.93[0.87 - 0.99]，P = 0.02）、LA增强（0.87，95% CI[0.76 - 0.99]，P = 0.04）、LV整体纵向（1.26，95% CI[1.02 - 1.55]，P = 0.03）、圆周（1.37，95% CI[1.08 - 1.73]，P = 0.008）和径向应变（0.89，95% CI[0.80 - 0.98]，P = 0.01）均为VA的独立决定因素。LV整体圆周应变＞ - 13.3%的患者与应变值≤ - 13.3%的患者相比，无事件生存率更差（P＜0.0001）。(4) CMR上的LA和LV应变机制与心肌炎患者的VA事件独立相关，独立于LV射血分数和钆延迟增强位置。将心肌应变参数纳入心肌炎的管理可能会改善风险分层。
