Temporal echocardiography findings in patients with fulminant myocarditis: beyond ejection fraction decline

Abstract

The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients. In this study, changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored. We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment. Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled. Conventional echocardiographic measurements were obtained, and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (>50%). Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified, and their changes with time were monitored in 14 FM patients. All patients had severely impaired cardiac function. Steep improvement in LVEF and GLS were observed within 6 days. Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal. In conclusion, FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days. The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.

Keywords

fulminant myocarditis / acute myocarditis / 2D speckle tracking echocardiography / left ventricular function / global longitudinal strain

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Acknowledgements

The project was supported by the grant from the National Natural Science Foundation of China (Nos. 81873535 and 81570367). We thank Dr. Jonathan R. Linder who gave us helpful suggestions in writing the manuscript.

Compliance with ethics guidelines

Houjuan Zuo, Rui Li, Fei Ma, Jiangang Jiang, Kun Miao, Haojie Li, Eike Nagel, Marijana Tadic, Hong Wang, and Dao Wen Wang declared no conflicts of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in the study. And this study was approved by the Research Ethics Committee of Tongji Hospital.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-019-0713-9 and is accessible for authorized users.

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