Affiliation:
1. Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
2. Department of Cardiology Cardiovascular Research Institute (CARIM), Maastricht University Medical Center Maastricht The Netherlands
3. Department of Cardiology, and Radiology and Nuclear Medicine Erasmus University Medical Center Rotterdam The Netherlands
4. Department of Cardiology Amsterdam University Medical Center Amsterdam The Netherlands
5. Department of Health Evidence, section Biostatistics Radboud University Medical Center Nijmegen The Netherlands
Abstract
Background
Late gadolinium enhancement and left ventricular (LV) ejection fraction on cardiovascular magnetic resonance (CMR) are prognostic markers, but their predictive value for incident heart failure or life‐threatening arrhythmias in acute myocarditis patients is limited. CMR‐derived feature tracking provides a more sensitive analysis of myocardial function and may improve risk stratification in myocarditis. In this study, the prognostic value of LV, right ventricular, and left atrial strain in acute myocarditis patients is evaluated.
Methods and Results
In this multicenter retrospective study, patients with CMR‐proven acute myocarditis were included. The primary end point was occurrence of major adverse cardiovascular events: all‐cause mortality, heart transplantation, heart failure hospitalizations, and life threatening arrhythmias. LV global longitudinal strain, global circumferential strain and global radial strain, right ventricular‐global longitudinal strain and left atrial strain were measured. Unadjusted and adjusted cox proportional hazard regression analysis were performed. In total, 162 CMR‐proven myocarditis patients were included (41 ± 17 years, 75% men). Mean LV ejection fraction was 51 ± 12%, and 144 (89%) patients had presence of late gadolinium enhancement. Major adverse cardiovascular events occurred in 29 (18%) patients during a follow‐up of 5.5 (2.2–8.3) years. All LV strain parameters were independent predictors of outcome beyond clinical features, LV ejection fraction and late gadolinium enhancement (LV‐global longitudinal strain: hazard ratio [HR] 1.07,
P
=0.02; LV‐global circumferential strain: HR 1.15,
P
=0.02; LV‐global radial strain: HR 0.98,
P
=0.03), but right ventricular or left atrial strain did not predict outcome.
Conclusions
CMR‐derived LV strain analysis provides independent prognostic value on top of clinical parameters, LV ejection fraction and late gadolinium enhancement in acute myocarditis patients, while left atrial and right ventricular strain seem to be of less importance.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
10 articles.
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