COVID-19 Myocarditis: Prognostic Role of Bedside Speckle-Tracking Echocardiography and Association with Total Scar Burden

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.

[1]  G. Hindricks,et al.  ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2—care pathways, treatment, and follow-up , 2021, European heart journal.

[2]  C. Lavalle,et al.  Prevalence and Clinical Implications of COVID-19 Myocarditis , 2021, Cardiac Electrophysiology Clinics.

[3]  F. Giallauria,et al.  The Role of Multimodality Imaging in Athlete’s Heart Diagnosis: Current Status and Future Directions , 2021, Journal of clinical medicine.

[4]  Alessandro Serio,et al.  Potential role of an athlete-focused echocardiogram in sports eligibility , 2021, World journal of cardiology.

[5]  R. Virmani,et al.  Pathological Evidence for SARS-CoV-2 as a Cause of Myocarditis , 2021, Journal of the American College of Cardiology.

[6]  S. Petersen,et al.  Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort , 2020, Journal of Cardiovascular Magnetic Resonance.

[7]  D. Mele,et al.  [Non-ischemic ventricular dysfunction in COVID-19 patients: characteristics and implications for cardiac imaging on the basis of current evidence]. , 2020, Giornale italiano di cardiologia.

[8]  A. Secinaro,et al.  Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance , 2020, Scientific Reports.

[9]  Jin Young Kim,et al.  COVID-19-related myocarditis in a 21-year-old female patient , 2020, European heart journal.

[10]  Lei Liu,et al.  First case of COVID-19 complicated with fulminant myocarditis: a case report and insights , 2020, Infection.

[11]  C. Basso,et al.  Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection , 2020, European heart journal.

[12]  J. Zamorano,et al.  Echocardiographic reference ranges for normal left ventricular layer-specific strain: results from the EACVI NORRE study. , 2020, European heart journal cardiovascular Imaging.

[13]  W. Gong,et al.  Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. , 2020, JAMA cardiology.

[14]  Z. Memish,et al.  The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China , 2020, International Journal of Infectious Diseases.

[15]  F. Clemenza,et al.  1232 Acute myocarditis: prognostic role of speckle tracking echocardiography and cardiac magnetic resonance , 2020 .

[16]  Matthias Gutberlet,et al.  Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. , 2018, Journal of the American College of Cardiology.

[17]  R. Blankstein,et al.  Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis. , 2017, Journal of the American College of Cardiology.

[18]  Jeroen J. Bax,et al.  Myocardial strain to detect subtle left ventricular systolic dysfunction , 2017, European journal of heart failure.

[19]  Patrizio Lancellotti,et al.  Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2016, European heart journal cardiovascular Imaging.

[20]  Patrizio Lancellotti,et al.  Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2016, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  H. Ko,et al.  Two-Dimensional Speckle-Tracking-Derived Segmental Peak Systolic Longitudinal Strain Identifies Regional Myocardial Involvement in Patients with Myocarditis and Normal Global Left Ventricular Systolic Function , 2015, Pediatric Cardiology.

[22]  Victor Mor-Avi,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[23]  Thomas H Marwick,et al.  Normal ranges of left ventricular strain: a meta-analysis. , 2013, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[24]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[25]  M. Cerqueira,et al.  Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. , 2002, Circulation.