title: Feature Tracking-Derived Peak Systolic Strain Compared to Late Gadolinium Enhancement in Troponin-Positive Myocarditis: A Case-Control Study.
abstract: Cardiac magnetic resonance (CMR) assesses myocardial involvement in myocarditis (MYO). Current techniques are qualitative, subjective, and prone to interpretation error. Feature tracking (FT) analyzes myocardial strain using CMR and has not been examined in MYO. We hypothesize that regional left ventricular (LV) strain is abnormal in MYO. Regional strain by FT was compared to late gadolinium enhancement (LGE) and troponin leak as measures of myocardial involvement. This single-center, retrospective CMR study reviewed patients with clinical MYO and structurally normal hearts who underwent CMR at our institution. Young adults with normal cardiac anatomy, function, and absent LGE served as controls. MYO patients with documented troponin leak and normal global ejection fraction (EF > 50 %) were included in comparison. FT determined regional myocardial peak systolic strain (pkS) in longitudinal and circumferential distributions. T tests compared strain values between cases and controls. Receiver operating characteristic curves determined pkS values with highest sensitivity and specificity for concurrent troponin leak and LGE. FT was performed on 57 patients: 37 MYO and 20 controls. Twenty-eight cases with normal EF, and 20 control patients were included in final analysis. Nearly all cases with normal function demonstrated abnormal regional pkS (27/28, 96 %). Cases had significantly diminished pkS when compared to controls in all regions except the longitudinal 2C distribution. FT-derived longitudinal and circumferential pkS is sensitive and specific in identifying myocardial involvement, namely the presence of troponin leak and LGE. FT may be a useful adjunctive, objective measure of myocardial involvement in patients with MYO and normal LV function.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of San Antonio/Baylor College of Medicine, 315 N. San Saba Street Suite 1135, San Antonio, TX, 78207, USA. justin.weigand@bcm.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Weigand
authors.affiliation: Department of Radiology and Pediatric Cardiology, Stony Brook Children's Hospital, 100 Nicolls Road, Stony Brook, NY, 11794, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
authors.affiliation: Department of Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Division of Pediatric Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1201, New York, NY, 10029, USA.
authors.forename: Shubhika
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Division of Pediatric Cardiology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1201, New York, NY, 10029, USA.
authors.forename: Santosh
authors.initials: S
authors.lastname: Uppu
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D003287:Contrast Media / Q000737:chemistry; D004452:Echocardiography; D005260:Female; D019786:Gadolinium DTPA / Q000737:chemistry; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging*; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013599:Systole; D014336:Troponin / Q000097:blood*; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media; D014336:Troponin; D019786:Gadolinium DTPA
keywords: Cardiovascular magnetic resonance imaging; Feature tracking; Myocardial delayed enhancement; Myocardial strain; Myocarditis