Altered Left Ventricular Tissue Velocities, Deformation and Twist in Children and Young Adults with Acute Myocarditis and Normal Ejection Fraction

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Acute myocarditis is a significant cause of sudden death in young adults, and accurate screening for subclinical disease is needed. The aim of this study was to test the hypothesis that newer measures of tissue deformation and twist can detect ventricular dysfunction in patients with myocarditis and preserved left ventricular ejection fractions (LVEFs).


Twenty-eight consecutive patients (median age, 26.5 years; interquartile range, 19.3–33.8 years) with normal LVEFs and cardiovascular magnetic resonance features of myocarditis were prospectively recruited. Left ventricular tissue velocities, deformation, and twist were measured and compared with values in 64 healthy controls (median age, 25.1 years; interquartile range, 13.5–31.7 years).


Patients with myocarditis had reduced annular e′ velocity and longitudinal and circumferential strain parameters (P < .01) but similar LVEFs. Reduced lateral e′ velocity (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.34–2.34), longitudinal strain (OR, 1.81; 95% CI, 1.38–2.38), circumferential early diastolic strain rate (OR, 1.31; 95% CI, 1.08–1.71), increased twist rate (OR, 1.02; 95% CI, 1.01–1.04), and earlier time to peak twist (OR, 0.80; 95% CI, 0.72–0.88) were identified as independent predictors of myocarditis, with abnormalities in any two of five predictors having 93% sensitivity and 91% specificity. Longitudinal strain parameters and lateral e′ velocity were improved at 1 year (P ≤ .03) but remained reduced compared with controls (P ≤ .02).


Patients with acute myocarditis and normal LVEFs had detectable left ventricular systolic and diastolic dysfunction on echocardiography. Tissue velocity, deformation, and twist parameters have the potential to improve the detection of patients with myocarditis and preserved LVEFs.

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