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)