Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, School of Medicine Southeast University Nanjing Jiangsu China.
Department of Radiology Affiliated Hospital of Guangdong Medical University Guangdong China.
J Am Heart Assoc. 2024 Jul 2;13(13):e032781. doi: 10.1161/JAHA.123.032781. Epub 2024 Jun 27.
This study assesses the diagnostic utility of strain parameters from cardiovascular magnetic resonance feature tracking across all cardiac chambers in patients with acute myocarditis, stratified by ejection fraction.
Our cohort included 65 patients with acute myocarditis and 25 healthy controls; all underwent cardiac magnetic resonance imaging. Patients were divided into 2 groups based on left ventricular ejection fraction (EF)with a 55% cutoff: acute myocarditis with preserved EF, EF ≥55%, n=48; and acute myocarditis with reduced EF, EF <55%, n=17. The control group matched for age and sex. Cardiovascular magnetic resonance feature tracking evaluated strain parameters across all cardiac chambers. Both acute myocarditis with preserved EF and acute myocarditis with reduced EF groups showed significant decreases in left atrial peak early negative strain rate compared with controls. The acute myocarditis with reduced EF group had significantly reduced left ventricular circumferential strain relative to acute myocarditis with preserved EF and controls. Receiver operating characteristic curve analysis confirmed the diagnostic accuracy in distinguishing patients with acute myocarditis with preserved EF from controls, with left atrial peak early negative strain rate achieving 92.9% specificity, left ventricular circumferential strain demonstrating an area under the curve of 0.832, and similarly effective results for left ventricular longitudinal strain and right ventricular longitudinal strain. Additionally, left atrial peak early negative strain rate and left ventricular circumferential strain showed significant correlations with troponin I levels, indicating myocardial injury.
Cardiovascular magnetic resonance feature-tracking-derived strain parameters, particularly left atrial peak early negative strain rate and left ventricular circumferential strain, effectively diagnose acute myocarditis across different EFs, enhancing diagnostic accuracy and facilitating early detection, notably in patients with preserved EF.
本研究评估了心脏磁共振特征追踪的应变参数在急性心肌炎患者中的诊断效用，按射血分数进行分层。
我们的队列包括 65 名急性心肌炎患者和 25 名健康对照者；所有患者均接受了心脏磁共振成像检查。根据左心室射血分数（EF）将患者分为 2 组，EF 有 55%的截止值：射血分数保留的急性心肌炎，EF≥55%，n=48；射血分数降低的急性心肌炎，EF<55%，n=17。对照组按年龄和性别匹配。心脏磁共振特征追踪评估了所有心脏腔室的应变参数。射血分数保留的急性心肌炎组和射血分数降低的急性心肌炎组的左心房峰值早期负应变率均显著低于对照组。与射血分数保留的急性心肌炎组和对照组相比，射血分数降低的急性心肌炎组的左心室圆周应变明显降低。受试者工作特征曲线分析证实了区分射血分数保留的急性心肌炎患者和对照组的诊断准确性，左心房峰值早期负应变率的特异性为 92.9%，左心室圆周应变的曲线下面积为 0.832，左心室纵向应变和右心室纵向应变也有类似的效果。此外，左心房峰值早期负应变率和左心室圆周应变与肌钙蛋白 I 水平呈显著相关，提示心肌损伤。
心脏磁共振特征追踪衍生的应变参数，特别是左心房峰值早期负应变率和左心室圆周应变，在不同 EF 水平下有效诊断急性心肌炎，提高了诊断准确性，并有助于早期发现，尤其是在射血分数保留的患者中。
