Left ventricular endocardial longitudinal dysfunction persists after acute myocarditis with preserved ejection fraction

Background. Recently, two­dimensional strain echocardiography was also validated in order to provide important information on myocardial dysfunction in patients with acute myocarditis (AM), even if no wall motion abnormalities are detected. In these patients, a significant longitudinal dysfunction have been recognized in acute phase. The aim of present study was to assess left ventricular (LV) myocardial deformation and changes over time in patients with AM with preserved ejection fraction detected by late gadolinium enhancement (LGE) magnetic resonance imaging. Methods. Thirty­five male patients with AM diagnoses and preserved systolic function based on of cardiac magnetic resonance imaging (MRI) were prospectively enrolled. On admission, echocardiography with measurements of global and segmental longitudinal (LS) strains were performed both at the endocardial (ENDO) and epicardial (EPI) levels. Findings were compared to 25 control subjects. Results. Twenty­six patients were also monitored over a 22­month follow­up (FU group). On admission, global ENDO­LS was poorer in magnitude in AM (­19.2±3.1) than in controls (­24.0±1.05) (p <0.0001), whereas EPI­LS was not different (­20.6±3.4 versus ­19.7±6 p=NS). A functional increase in magnitude in both ENDO­LS (­20.8±5.4, p=NS) and EPI­LS (­22.6±4.6, p=0.02) was found in FU versus AM patients. Conclusions. The present study demonstrates a steady ENDO­LS impairment in infarct­like AM during a two­year follow­up period, despite a preserved LV ejection fraction.