Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance

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Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance

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Chinali M, Franceschini A, Ciancarella P, Lisignoli V, Curione D, Ciliberti P, Esposito C, Del Pasqua A, Rinelli G, Secinaro A.

Sci Rep. 2020 Jul 9;10(1):11321. doi: 10.1038/s41598-020-68048-5.

PMID: 32647322

Take Home Points:

  • Speckle tracking echocardiography is helpful to systolic functional abnormalities in children with focal myocarditis and normal ejection fraction.
  • Regions of reduced longitudinal strain on echocardiography corresponded to regions of myocardial edema detected by CMR imaging.
  • Reduced global longitudinal strain was associated with a higher percentage of myocardial edema.

Dr Inga Voges

Commentary from Dr. Inga Voges (Kiel, Germany), section editor of Pediatric Cardiology Journal Watch:  This retrospective study assessed the ability of speckle tracking echocardiography (STE) in children and adolescents with focal myocarditis and normal ejection fraction (EF) to identify acute systolic functional abnormalities and persistent subclinical systolic dysfunction.

33 pediatric patients were included according to the study flow chart (Figure 1). Echocardiography was performed on admission and at discharge. Echocardiographic parameters assessed in this study included left ventricular (LV) diameters and wall thickness, LVEF as well as LV inflow velocities (E, peak early diastolic filling; A, late diastolic peak velocities). Tissue Doppler was performed to calculate E/e’ ratio. STE was used to measure global and regional longitudinal strain.

CMR was performed on admission to measure LV function as well as to assess myocardial fibrosis and edema.

In all patients, ejection fraction was normal on admission and none of the patients presented with LV hypertrophy or dilatation. There was a normal pattern of diastolic filling with no evidence of increased LV filling pressure. Global longitudinal strain was reduced in 58% of the patients with the most affected regions being the inferoseptal, inferior and inferolateral segments. CMR imaging revealed a similar regional distribution of myocardial edema. Reduction in global longitudinal strain was associated with a higher percentage of myocardial edema (Figure 2). Echocardiography at discharge demonstrated a full recovery in 13 and persistent subclinical dysfunction in 6 children. Patients with persistent dysfunction were found to have more myocardial fibrosis during a follow up CMR study.

In summary, the authors were able to demonstrate the usefulness of STE in identifying areas of regional (subclinical) systolic dysfunction corresponding to areas of myocardial edema. This relatively small study motivates for further research in this field.

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