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Myocardial strain changes as assessed by feature tracking CMR in patients with acute myocarditis and preserved ejection fraction. Impact on prognosis
Session:
SESSÃO DE POSTERS 19 - IMAGEM NAS MIOCARDIOPATIAS
Speaker:
João Mendes Cravo
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Cartazes
FP Number:
---
Authors:
João Mendes Cravo; Marta Vilela; Miguel Menezes; Margarida Martins; Ana Beatriz Garcia; Catarina Gregório; Joana Rigueira; Fausto J.Pinto; Ana G. Almeida; Ana Abrantes
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">I</span></span></span></span><span style="font-size:18px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">ntroduction: Acute myocarditis is in most cases a benign condition presenting with preserved ejection fraction. However, its long-term evolution is still largely unknown. Despite most patients presenting with preserved EF, we believe myocardial deformation changes may be present along with late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">Purpose: To assess myocardial strain using feature tracking CMR analysis, in patients with acute myocarditis and normal EF and evaluate its relationship with ventricular function and adverse events at 3-year follow-up.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">Methods: 111 consecutive patients (36±12 years, 89 males) with acute myocarditis were included. Diagnosis was based in clinical data, typical ECG and biomarkers rise, normal coronary arteries and CMR study based on the Lake Louise criteria. Inclusion criteria included an EF >55% in the acute phase and a yearly follow-up for 3 years. A control group of 27 individuals was included. The CMR study, at baseline and follow-up, included a conventional SSFP and LGE assessment. Applying a feature tracking analysis method (cvi42, Circle), peak global longitudinal (GLS), circumferential and radial strain were obtained. The amount of LGE was quantified from a stack of short axis as a percentage of mass from the global myocardial mass.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">Results: During a follow-up of 2.7±1.8 years, 4 patients were hospitalized for myocarditis recurrence. Patients remained in NYHA Class I. EF at follow-up showed no difference from the baseline study (62.8±2.6% versus 61.3±4.5%, p=0.81). In comparison with controls, there was a lower GLS at baseline, showing improvement at 3-year follow-up (-13.5±-2.3 versus -18.1±-4.5%). The circumferential strain was significantly lower at the baseline and at follow-up. Mean values of baseline circumferential strain were significantly associated with the LGE% (R=0.66, p=0.004). At follow-up, a group of 22 patients showed a decrease of >10% of circumferential strain, maintaining a preserved EF, which was associated with a larger LGE% (p=0.003) and a lower baseline circumferential strain (p=0.01).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:18px"><span style="font-family:Cambria,serif"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">Conclusion: In patients with acute myocarditis and preserved EF, tissue tracking CMR showed subclinical changes in myocardial deformation. Circumferential strain in the acute phase was inversely associated with the myocardial lesion extent and was associated with lower circumferential strain at follow-up despite preserved EF, corresponding to a subclinical marker of dysfunction.</span></span></span></span></p>
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