Search

Background: The diagnosis of myocarditis is challenging, especially in case of normal left ventricular systolic function. The aim of this study is to test the hypothesis that 2D speckle tracking echocardiography (2DSTE) can detect subclinical left ventricular (LV) dysfunction in patients with myocarditis and preserved LV function without regional wall motion abnormalities and that regional strain analysis can correlate with cardiac magnetic resonance (CMR) findings., Methods: Study population consisted of 25 consecutive patients with myocarditis and 19 controls. All patients underwent a full echocardiographic study at the first day of their admission and in addition to conventional echocardiographic measurements, global longitudinal and circumferential strain of the left ventricle (LVGLS, LVCS accordingly), as well as regional strains of the lateral wall, were estimated. Moreover, all patients underwent a CMR scan during the first week from their admission., Results: Although there was no statistical difference between the two groups of patients in systolic function, myocarditis patients demonstrated significantly impaired LVGLS (-16.5 ± 2.2 vs -20.5 ± 1.3%, p < 0.0001) and LVCS (-16.4 ± 3.7 vs -20.9 ± 2%, p = 0.002), as well as segmental longitudinal strains of the lateral wall. CMR in all myocarditis patients revealed late gadolinium enhancement in the lateral left ventricle free wall., Conclusions: In patients with acute myocarditis with preserved ejection fraction, 2DSTE evaluation appears to be a promising, useful noninvasive and inexpensive tool in addition to existing methods used for the diagnosis of acute myocarditis, since it seems to be able to identify myocardial fibrosis early in the setting of the disease., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to evaluate the possible relationship between the degree of physical activity at the onset of myocardial infarction and thrombolysis outcome., Methods: A total of 351 consecutive patients, who underwent thrombolysis due to ST elevation acute myocardial infarction, were prospectively studied. Patients were classified into three groups according to a generally accepted scale: group I patients had experienced symptoms during exertion, group II when sitting and group III during sleep or when reclining., Results: There was a significantly increased chance of either intravenous thrombolysis effectiveness or cardiac survival probability with increasing physical activity at the onset of myocardial infarction. In particular, group I patients had a significantly higher incidence of complete ST-segment resolution (P<0.001 for both II vs. I and III vs. I groups) or TIMI 3 flow in the infarct-related artery (II vs. I: P=0.002, and III vs. I: P<0.001) and less compromised left ventricular function (P<0.001 for both II vs. I and III vs. I) by both univariate and multivariate analysis. Moreover, although the degree of physical activity was associated with lower in-hospital (II vs. I: P=0.048, and III vs. I: P=0.01), and cardiac mortality at 39 months (II vs. I: P=0.002, and III vs. I: P<0.001) by univariate analysis, this did not hold true by multivariate analysis., Conclusions: In conclusion, the degree of physical activity at the onset of myocardial infarction may be positively associated with acute success of intravenous thrombolysis and this may favorably influence short- and long-term cardiac survival.