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Purpose: An early and reliable diagnosis of acute myocardial inflammation may significantly reduce the number of unnecessary invasive cardiac tests and protracted hospital stay in patients (pts) with suspected myocarditis. We hypothesise that changes in myocardial deformation, assessed by speckle tracking echocardiography, could provide a robust method to identify pts with myocardial injury secondary to acute focal myocarditis.Methods: Fifty-two consecutive pts (40 male; 12 female; mean age, 27±7 years) with clinically suspected myocarditis were prospectively evaluated. All pts underwent 2D echocardiography (including speckle tracking for assessment of circumferential (C), radial (R) and longitudinal (L) strain), cardiac MRI (T2 weighted and post contrast gadolinium enhancement) to assess acute myocardial injury and coronary arteriography or multislice CTA to exclude coronary artery disease (28 and 24 pts respectively).Results: Regional wall motion abnormalities were present in 11 pts. Left ventricular ejection fraction (LVEF) was normal in all but 8 (67% vs. 47%). An epicardial pattern of high T2 signal and abnormal patchy myocardial delayed enhancement was present in 49 (94%). Global L and C strain was normal in pts with preserved LVEF and attenuated in those with reduced (-18 (6) vs. -22 (5) and -17(6) vs. -24(9), for L and C; p<0.05). In contrast, all areas of myocardial injury, as assessed by CMR were closely matched with attenuated segmental C and L strain (figure).Conclusions: Attenuated segmental C and L strain identified areas of myocardial injury secondary to acute focal myocarditis. Incorporating assessment of myocardial deformation into the routine early assessment of patients with suspected myocarditis may provide higher diagnostic yield.