P485Relationship between left ventricular torsion and troponin levels in patients with acute myocarditis and preserved ejection fraction


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Abstract

Background: Myocarditis represents a challenging diagnosis mimicking a variety of clinical patterns from asymptomatic electrocardiographic (ECG) abnormalities to sudden death. Conventional two dimensional echocardiography can detect regional wall motion abnormalities and dilated ventricles, however in the cases with normal ejection fraction its role appears to be limited. According to LV mechanics and the pathophysiology of the disease with primary insult of the subepicardium and midwall the hypothesis that LV torsion and segmental mechanics are affected despite the normal ejection fraction is tested.Aim: The aim of this study was to determine whether speckle tracking imaging (STI) can contribute to the earlier diagnosis and understanding of acute myocarditis with preserved contractility. Left ventricular torsion (Tor), apical and basal rotation and both global and regional strain values were calculated with STI in the acute phase of myocarditis.Methods: 50 patients with chest pain, abnormal ECGs and preserved ejection fraction (>45%) were included in the study after the angiographic exclusion of coronary artery disease and a CMRI study with the potential diagnosis of myocarditis. Routine and STI echocardiography parameters were measured and compared with 50 healthy aged-matched controls. LV torsion and apical rotation were estimated and correlated with troponin release, a marker of myocardial necrosis. Global and segmental strain using the AFI method (Automated Function Imaging) was estimated in both groups.Results: Myocarditis patients showed decreased left ventricular torsion ( 10.30± 4.92 VS 14.28±4.30 degrees, respectively, p <0.01) and apical rotation values (4.74 ±3.77 VS 8.7372±3.85 degrees, respectively p=0.003), when compared to controls. Troponin elevation was found in 25 patients (50%) with mean values 14.84±23.79 ng/ml. A strong correlation between troponin elevation and LV torsion impairment was found (r=-0,784, P< 0.001). Global strain values (-17.35±3.08 % vs. -20.09±2.63 %, p= NS) were not statistically different compared to controls, reflecting the preserved longitudinal contractility in these patients.Conclusion: Speckle tracking imaging assessment of acute myocarditis revealed abnormal LV torsion, which was strongly correlated to the level of troponin release, whereas longitudinal strain was not significantly affected.

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