Diagnostic role of strain imaging in atypical myocarditis by echocardiography and cardiac MRI.
Background: The diagnosis of myocarditis presenting as isolated acute chest pain with elevated troponins but normal systolic function is challenging with significant drawbacks even for the gold-standard endomyocardial biopsy.Objective: This study aimed to evaluate the diagnostic role of strain imagi...
| Publicado en: | Pediatric Radiology Vol. 48; no. 6; pp. 835 - 843 |
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| Autores principales: | , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
Jun2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129629557&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 129629557 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03010449 O03 jtl: Pediatric Radiology issn: 03010449 maglogo: N pubinfo: dt: Jun2018 vid: 48 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 129629557 129629557 NLM29651605 10.1007/s00247-017-4061-0 NLM29651605 129629557 ppf: 835 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Diagnostic role of strain imaging in atypical myocarditis by echocardiography and cardiac MRI. aug: au: Wisotzkey, Bethany L. Soriano, Brian D. Albers, Erin L. Ferguson, Mark Buddhe, Sujatha affil: Division of Pediatric Cardiology, Johns Hopkins All Children’s Hospital, 501 Sixth Avenue South, 33701, St. Petersburg, FL, USA sug: subj: Magnetic Resonance Imaging Methods Echocardiography Methods Myocardial Diseases Chest Pain Contrast Media Troponin Blood Adolescence Retrospective Design Image Enhancement Methods Female Diagnosis, Differential Male Acute Disease Image Interpretation, Computer Assisted Methods Adolescent: 13-18 years Female Male ab: Background: The diagnosis of myocarditis presenting as isolated acute chest pain with elevated troponins but normal systolic function is challenging with significant drawbacks even for the gold-standard endomyocardial biopsy.Objective: This study aimed to evaluate the diagnostic role of strain imaging by echocardiography and cardiac MRI in these patients.Materials and Methods: This was a retrospective review of children with cardiac MRI for acute chest pain with elevated troponins compared to normal controls. Echocardiographic fractional shortening, ejection fraction, speckle-tracking-derived peak longitudinal, radial, and circumferential strain were compared to cardiac MRI ejection fraction, T2 imaging, late gadolinium enhancement, speckle-tracking-derived peak longitudinal strain, radial strain, and circumferential strain.Results: Group 1 included 10 subjects diagnosed with myocarditis, 9 (90%) males with a median age of 15.5 years (range: 14-17 years) compared with 10 age-matched controls in group 2. All subjects in group 1 had late gadolinium enhancement consistent with myocarditis and troponin ranged from 2.5 to >30 ng/ml. Electrocardiogram changes included ST segment elevation in 6 and abnormal Q waves in 1. Qualitative echocardiographic function was normal in both groups and mean fractional shortening was similar (35±6% in group 1 vs. 34±4% in group 2, P=0.70). Left ventricle ejection fraction by cardiac MRI, however, was lower in group 1 (52±9%) compared to group 2 at (59±4%) (P=0.03). Cardiac MRI derived strain was lower in group 1 vs. group 2 for speckle-tracking-derived peak longitudinal strain (-12.8±2.8% vs. -17.1±1.5%, P=0.001), circumferential strain (-12.3±3.8% vs. -15.8±1.2%, P=0.020) and radial strain (13.6±3.7% vs. 17.2±3.2%, P=0.040). Echocardiography derived strain was also lower in group 1 vs. group 2 for speckle-tracking-derived peak longitudinal strain (-15.6±3.9% vs. -20.8±2.2%, P<0.002), circumferential strain (-16±3% vs. -19.8±1.9%, P<0.003) and radial strain (17.3±6.1% vs. 24.8±6.3%, P=0.010).Conclusion: In previously asymptomatic children, myocarditis can present with symptoms of acute chest pain suspicious for coronary ischemia. Cardiac MRI and echocardiographic strain imaging are noninvasive, radiation-free tests of immense diagnostic utility in these situations. Long-term studies are needed to assess prognostic significance of these findings. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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