PREDICTIVE PARAMETERS OF VENTRICULAR ARRHYTHMIAS IN ACUTE MYOCARDITIS
WITH PRESERVED LVEF
Abstract
Background: Myocarditis have variable clinical presentation, evolution
and prognosis. Aim of our study was to evaluate the value of speckle
tracking echocardiography and cardiac magnetic resonance (CMR) in the
prediction of ventricular arrhythmias and other cardiovascular adverse
events in patients with acute myocarditis, at hospital admission.
Methods: 70 patients (62 M, 8 F; mean age 31,3±13,2) with myocarditis
and preserved left ventricle ejection fraction (LVEF) were enrolled.
Electrocardiogram (ECG), continuous ECG monitoring, echocardiography
with measurement of global longitudinal strain of the left ventricle
(GLS), mechanical dispersion (MD) and CMR with quantitative measurement
of delayed enhancement (DE) were performed. Adverse events were assessed
(arrhythmias, heart failure, cardiogenic shock, syncope) during
in-hospital stay. Results: We found a significant greater amount of DE
mass in patients with cardiac arrhythmias (p = 0,01), but not of edema
(p = 0,57). GLS was significantly impaired in patients with ventricular
arrhythmias (p = 0,04), conversely MD was not significantly prolonged in
this setting (p = 0,16). GLS > - 19.2% (sens 100%, specif
55,7%) and a DE mass >9,9 gr (sens 100%; specif. 58,6%)
had the best sensitivity and specificity to identify patients with
cardiac arrhythmias. Compared to GLS, DE mass showed a stronger
association with ventricular arrhythmias (p < 0,001).
Conclusions: in our study DE mass and GLS were associated with
ventricular arrhythmias in patients with acute myocarditis and preserved
LVEF. DE showed the stronger association with the occurrence of
ventricular arrhythmias.