Aims
Data derived by cardiac magnetic resonance (CMR) feature tracking suggest that not only left ventricular but also left atrial function is impaired in patients with acute myocarditis. Therefore we investigated the diagnostic value of speckle tracking echocardiography of the left ventricle and left atrium in patients with acute myocarditis and normal left ventricular ejection fraction (LVEF).

Methods and Results

31 patients with acute myocarditis confirmed by CMR according to the Lake Louise criteria and 20 healthy controls were analyzed including global longitudinal strain (GLS) and left atrial (LA) strain parameters. Although preserved LVEF was present in both groups, GLS was significantly lower in patients with acute myocarditis (GLS -19.1±1.8 % vs. GLS -22.1±1.7%, p<0.001).  Further diastolic dysfunction measured by E/E’ mean was significantly deteriorated in the myocarditis group compared to the control group (E/E’mean 6,5±1.7 vs. 5.5±1.0, p=0.024). In 26 cases with myocarditis left atrial strain parameters could be investigated. LA reservoir function (46.6±10.6% vs. 55.5±10.8%, p=0.007) and LA conduit function (-32.8±8.7% vs. -39.4±9.5, p=0.018) were significantly reduced in patients with acute myocarditis compared to healthy controls. 

Conclusion

In patients with acute myocarditis and preserved LVEF not only GLS but also LA reservoir and LA conduit function were impaired compared to healthy controls indicating ventricular diastolic dysfunction and elevated LV filling pressures.