2D Left Ventricular Global Longitudinal Strain
LV-GLS had the highest overall effect size compared to LVEDD and LVEF
with a SMD of |1.98| (95% CI:
|1.51| - |2.45|, p<0.01),
with no significant heterogeneity (76%). All six studies demonstrated
statistically significant differences in LV-GLS between myocarditis
populations and controls, irrespective of baseline LVEF. Interestingly,
Caspar et al. demonstrated that two-dimensional LV-GLS was impaired in
patients with myocarditis (-17.8% vs -22.1%, p<0.01) as were
2D layer-specific sub-epicardial GLS (-15.4% vs -19.7%,
p<0.01) and sub-endocardial GLS (-20.7% vs -25.1%,
p<0.0001), even two years after the initial myocarditis event(17). Di Bella et al.
demonstrated that longitudinal strain was significantly lower in areas
of late gadolinium enhancement (p=0.04), and that GLS was shown to have
a moderate predictive value of distinguishing the two groups with an AUC
of 0.73 (95% CI: 0.66-0.79)