Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Left Atrial Strain Derived From Cardiac Magnetic Resonance Imaging Can Predict Outcomes of Patients With Acute Myocarditis

  • Jimin Lee (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Ki Seok Choo (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Yeon Joo Jeong (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Geewon Lee (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Minhee Hwang (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute) ;
  • Maria Roselle Abraham (Department of Cardiology, University of California) ;
  • Ji Won Lee (Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute)
  • Received : 2022.11.16
  • Accepted : 2023.03.10
  • Published : 2023.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval [CI], 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.

Keywords

Acknowledgement

We acknowledge the assistance of Kwang Min Lee (KM consulting) with the statistical analysis.

References

  1. Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet 2012;379:738-747
  2. Kasper EK, Agema WR, Hutchins GM, Deckers JW, Hare JM, Baughman KL. The causes of dilated cardiomyopathy: a clinicopathologic review of 673 consecutive patients. J Am Coll Cardiol 1994;23:586-590
  3. Drory Y, Turetz Y, Hiss Y, Lev B, Fisman EZ, Pines A, et al. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol 1991;68:1388-1392
  4. Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis--diagnosis, treatment options, and current controversies. Nat Rev Cardiol 2015;12:670-680
  5. Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006;114:1581-1590
  6. Grun S, Schumm J, Greulich S, Wagner A, Schneider S, Bruder O, et al. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol 2012;59:1604-1615
  7. Kindermann I, Kindermann M, Kandolf R, Klingel K, Bultmann B, Muller T, et al. Predictors of outcome in patients with suspected myocarditis. Circulation 2008;118:639-648
  8. Georgiopoulos G, Figliozzi S, Sanguineti F, Aquaro GD, di Bella G, Stamatelopoulos K, et al. Prognostic impact of late gadolinium enhancement by cardiovascular magnetic resonance in myocarditis: a systematic review and metaanalysis. Circ Cardiovasc Imaging 2021;14:e011492
  9. Farzaneh-Far A, Romano S. Imaging and impact of myocardial strain in myocarditis. JACC Cardiovasc Imaging 2020;13:1902-1905
  10. Lee JW, Jeong YJ, Lee G, Lee NK, Lee HW, Kim JY, et al. Predictive value of cardiac magnetic resonance imaging-derived myocardial strain for poor outcomes in patients with acute myocarditis. Korean J Radiol 2017;18:643-654
  11. Fischer K, Obrist SJ, Erne SA, Stark AW, Marggraf M, Kaneko K, et al. Feature tracking myocardial strain incrementally improves prognostication in myocarditis beyond traditional CMR imaging features. JACC Cardiovasc Imaging 2020;13:1891-1901
  12. Singh A, Medvedofsky D, Mediratta A, Balaney B, Kruse E, Ciszek B, et al. Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging 2019;35:23-32
  13. Li Y, Xu Y, Tang S, Jiang X, Li W, Guo J, et al. Left atrial function predicts outcome in dilated cardiomyopathy: fast long-axis strain analysis derived from MRI. Radiology 2022;302:72-81
  14. Leng S, Ge H, He J, Kong L, Yang Y, Yan F, et al. Long-term prognostic value of cardiac MRI left atrial strain in ST-segment elevation myocardial infarction. Radiology 2020;296:299-309
  15. Rausch K, Scalia GM, Sato K, Edwards N, Lam AK, Platts DG, et al. Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease. Int J Cardiovasc Imaging 2021;37:81-90
  16. Doerner J, Bunck AC, Michels G, Maintz D, Baessler B. Incremental value of cardiovascular magnetic resonance feature tracking derived atrial and ventricular strain parameters in a comprehensive approach for the diagnosis of acute myocarditis. Eur J Radiol 2018;104:120-128
  17. Pastore MC, Degiovanni A, Spinoni E, De Zan G, Carassia C, Patti G. Left atrial strain reduction in acute myocarditis and its association with incident atrial fibrillation. Eur Heart J Cardiovasc Imaging 2002;23(Supplement 1):i607-i608
  18. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on myocardial and pericardial diseases. Eur Heart J 2013;34:2636-2648, 2648a-2648d
  19. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009;53:1475-1487
  20. Aquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, et al. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function: ITAMY study. J Am Coll Cardiol 2017;70:1977-1987
  21. Kowallick JT, Kutty S, Edelmann F, Chiribiri A, Villa A, Steinmetz M, et al. Quantification of left atrial strain and strain rate using cardiovascular magnetic resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 2014;16:60
  22. Park SH, Han K, Park SY. Mistakes to avoid for accurate and transparent reporting of survival analysis in imaging research. Korean J Radiol 2021;22:1587-1593
  23. Brecht A, Oertelt-Prigione S, Seeland U, Rucke M, Hattasch R, Wagelohner T, et al. Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr 2016;29:750-758
  24. Frydas A, Morris DA, Belyavskiy E, Radhakrishnan AK, Kropf M, Tadic M, et al. Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail 2020;7:1956-1965
  25. Jain V, Ghosh R, Gupta M, Saijo Y, Bansal A, Farwati M, et al. Contemporary narrative review on left atrial strain mechanics in echocardiography: cardiomyopathy, valvular heart disease and beyond. Cardiovasc Diagn Ther 2021;11:924-938
  26. Yan P, Sun B, Shi H, Zhu W, Zhou Q, Jiang Y, et al. Left atrial and right atrial deformation in patients with coronary artery disease: a velocity vector imaging-based study. PLoS One 2012;7:e51204
  27. Dick A, Schmidt B, Michels G, Bunck AC, Maintz D, Baessler B. Left and right atrial feature tracking in acute myocarditis: a feasibility study. Eur J Radiol 2017;89:72-80
  28. Vasquez N, Ostrander BT, Lu DY, Ventoulis I, Haileselassie B, Goyal S, et al. Low left atrial strain is associated with adverse outcomes in hypertrophic cardiomyopathy patients. J Am Soc Echocardiogr 2019;32:593-603.e1
  29. Raafs AG, Vos JL, Henkens MTHM, Slurink BO, Verdonschot JAJ, Bossers D, et al. Left atrial strain has superior prognostic value to ventricular function and delayed-enhancement in dilated cardiomyopathy. JACC Cardiovasc Imaging 2022;15:1015-1026
  30. Modin D, Biering-Sorensen SR, Mogelvang R, Alhakak AS, Jensen JS, Biering-Sorensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging 2019;20:804-815
  31. Jia F, Chen A, Zhang D, Fang L, Chen W. Prognostic value of left atrial strain in heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2022;9:935103
  32. Schneider JN, Jahnke C, Cavus E, Chevalier C, Bohnen S, Radunski UK, et al. Feature tracking cardiovascular magnetic resonance reveals recovery of atrial function after acute myocarditis. Int J Cardiovasc Imaging 2022;38:2003-2012
  33. Haji K, Wong C, Wright L, Ramkumar S, Marwick TH. Left atrial strain performance and its application in clinical practice. JACC Cardiovasc Imaging 2019;12:1093-1101
  34. Kadappu KK, Thomas L. Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ 2015;24:224-233
  35. Nguyen J, Weber J, Hsu B, Mulyala RR, Wang L, Cao JJ. Comparing left atrial indices by CMR in association with left ventricular diastolic dysfunction and adverse clinical outcomes. Sci Rep 2021;11:21331
  36. Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, et al. The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 2013;82:296-301