Journal of Cardiovascular Magnetic Resonance (Aug 2023)

Predictive value of cardiac magnetic resonance right ventricular longitudinal strain in patients with suspected myocarditis

  • Benedikt Bernhard,
  • Giulin Tanner,
  • Davide Garachemani,
  • Aaron Schnyder,
  • Kady Fischer,
  • Adrian T. Huber,
  • Yasaman Safarkhanlo,
  • Anselm W. Stark,
  • Dominik P. Guensch,
  • Jonathan Schütze,
  • Simon Greulich,
  • Jessica A. M. Bastiaansen,
  • Maryam Pavlicek-Bahlo,
  • Dominik C. Benz,
  • Raymond Y. Kwong,
  • Christoph Gräni

DOI
https://doi.org/10.1186/s12968-023-00957-6
Journal volume & issue
Vol. 25, no. 1
pp. 1 – 14

Abstract

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Abstract Background Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR. Methods Patients referred for CMR, meeting clinical criteria for suspected myocarditis and no other cardiomyopathy were enrolled in a dual-center register cohort study. Ejection fraction (EF), GLS and tissue characteristics were assessed in both ventricles to assess their association to first major adverse cardiovascular events (MACE) including hospitalization for heart failure (HF), ventricular tachycardia (VT), recurrent myocarditis and death. Results Among 659 patients (62.8% male; 48.1 ± 16.1 years), RV GLS was impaired (> − 15.4%) in 144 (21.9%) individuals, of whom 76 (58%), 108 (77.1%), 27 (18.8%) and 40 (32.8%) had impaired right ventricular ejection fraction (RVEF), impaired left ventricular ejection fraction (LVEF), RV late gadolinium enhancement (LGE) or RV edema, respectively. After a median observation time of 3.7 years, 45 (6.8%) patients were hospitalized for HF, 42 (6.4%) patients died, 33 (5%) developed VT and 16 (2.4%) had recurrent myocarditis. Impaired RV GLS was associated with MACE (HR = 1.07, 95% CI 1.04–1.10; p < 0.001), HF hospitalization (HR = 1.17, 95% CI 1.12–1.23; p < 0.001), and death (HR = 1.07, 95% CI 1.02–1.12; p = 0.004), but not with VT and recurrent myocarditis in univariate analysis. RV GLS lost its association with outcomes, when adjusted for RVEF, LVEF, LV GLS and LV LGE extent. Conclusion RV strain is associated with MACE, HF hospitalization and death but has neither independent nor incremental prognostic value after adjustment for RV and LV function and tissue characteristics. Therefore, assessing RV GLS in the setting of myocarditis has only limited value.

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