Predictive Value of Cardiac Magnetic Resonance Imaging-Derived Myocardial Strain for Poor Outcomes in Patients with Acute Myocarditis.
10.3348/kjr.2017.18.4.643
- Author:
Ji Won LEE
1
;
Yeon Joo JEONG
;
Geewon LEE
;
Nam Kyung LEE
;
Hye Won LEE
;
Jin You KIM
;
Bum Sung CHOI
;
Ki Seok CHOO
Author Information
1. Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea.
- Publication Type:Original Article
- Keywords:
Myocarditis;
Magnetic resonance imaging;
Major adverse cardiovascular events;
Ventricular dysfunction;
Left ventricle;
Strain
- MeSH:
Echocardiography;
Follow-Up Studies;
Gadolinium;
Heart Ventricles;
Humans;
Kaplan-Meier Estimate;
Magnetic Resonance Imaging;
Myocarditis*;
Retrospective Studies;
Ventricular Dysfunction
- From:Korean Journal of Radiology
2017;18(4):643-654
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis. MATERIALS AND METHODS: We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (Ecc(SAX)), radial strain (Err(SAX)) from mid-ventricular level short-axis cine views and LV longitudinal strain (Ell(LV)), radial strain (Err(Lax)) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. RESULTS: During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, Ecc(SAX), Err(SAX), Ell(LV), and Err(Lax) values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an Err(Lax) value ≤ 9.48%. Multivariable backward regression analysis revealed that Err(Lax) values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CONCLUSION: CMR-derived Err(Lax) values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.
