SPECKLE TRACKING ECHOCARDIOGRAPHY ANALYSIS OF GLOBAL AND REGIONAL MYOCARDIAL STRAIN IN DIAGNOSIS AND FOLLOW-UP OF THE PATIENT WITH MYOPERICARDITIS/PRIMJENA EHOKARDIOGRAFIJE S ANALIZOM GLOBALNE I REGIONALNE SISTOLICKE DEFORMACIJE U DIJAGNOZI I PRACENJU BOLESNIKA S MIOPERIKARDITISOM

SPECKLE TRACKING ECHOCARDIOGRAPHY ANALYSIS OF GLOBAL AND REGIONAL MYOCARDIAL STRAIN IN DIAGNOSIS AND FOLLOW-UP OF THE PATIENT WITH MYOPERICARDITIS/PRIMJENA EHOKARDIOGRAFIJE S ANALIZOM GLOBALNE I REGIONALNE SISTOLICKE DEFORMACIJE U DIJAGNOZI I PRACENJU BOLESNIKA S MIOPERIKARDITISOM

Myopericarditis is inflammatory disease caused by various, often unidentified, factors. Although considered the gold standard for diagnosis of myocarditis, endomyocardial biopsy in clinical pactice is often substituted with clinical, biochemical and imaging parameters. Echocardiography with speckle...

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Published in:Acta clinica Croatica (Tisak) Vol. 63; no. S1; p. 75
Main Authors: Roginic, Sinisa, Mustapic, Vito, Knaflec, Tereza, Roginic, Ma, Macina, Andrija Skopljanac, Stambuk, Kresimir
Format: Journal Article
Language:English
Published: Klinicki bolnicki centar Sestre milosrdnice 15-03-2024
Subjects:
Angiography
Care and treatment
Case studies
Diagnosis
Echocardiography
Health aspects
Myocarditis
Pericarditis
Vaccination
Croatia
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Summary:Myopericarditis is inflammatory disease caused by various, often unidentified, factors. Although considered the gold standard for diagnosis of myocarditis, endomyocardial biopsy in clinical pactice is often substituted with clinical, biochemical and imaging parameters. Echocardiography with speckle tracking strain analysis is a valuable tool for diagnosis of myocarditis, estimation of regional and global systolic function showing good correlation with cardiac magnetic resonance imaging (cMRI). We present the case of a 19-year-old male with chest pain, elevated troponin and ST segment elevation who underwent urgent coronary angiography. Normal angiogram steered diagnosis toward myopericarditis, considering information about recent enterocolitis and vaccination against SARS-CoV-2. Transthoracal echocardiography with speckle tracking analysis showed longitudinal strain reduction in several segments of the left ventricle. Small pericardial effusion alongside those segments was also found supporting our diagnosis. After 3 months of treatment with antiinflammatory drugs, ACE inhibitor and beta blocker, the patient recovered and a repeated echo showed complete recovery of systolic function without pericardial effusion. We conclude that echocardiography, including global and regional longitudinal strain analysis, is a valuable diagnostic tool in patients with myopericarditis, complementary with not widely available cMRI. It can detect subtle systolic dysfunction not visible with conventional echocardiography, thus having implications on therapy and prognosis. Key words: myopericarditis, speckle tracking echocardiography, GLS Mioperikarditis je upalna bolest uzrokovana brojnim, cesto nepoznatim cimbenicima. Definitivna dijagnoza zahtjeva endomiokardijalnu biopsiju, no u klinickoj je praksi najcesce zamjenjuju kombinacija klinickih podataka, nalaza biokemijskih markera i slikovnih pretraga. Ehokardiografija s analizom sistolicke deformacije (''straina'') vazan je alat u dijagnozi, procjeni regionalne i globalne sistolicke funkcije koja pokazuje dobru korelaciju sa magnetskom rezonancom srca (cMRI). Predstavljamo slucaj 19-godisnjeg muskarca s bolovima u prsima, povisenim vrijednostima troponina i elevacijom ST spojnice koji je upucen na hitnu koronarografiju. Nakon urednog nalaza koronarografije postavljena je sumnja na mioperikarditis, pogotovo u svjetlu nedavnog enterokolitisa i cijepljenja protiv SARS-CoV-2. Transtorakalnom ehokardiografijom s analizom deformacije miokarda nadeno je ostecenje longitudinalne sistolicke deformacije u vise segmenata miokarda lijeve klijetke te prateci mali perikardijalni izljev sto se uklapa u dijagnozu. Nakon tri mjeseca terapije protuupalnim lijekovima, ACE inhibitorom i beta blokatorom bolesnik se potpuno oporavio, s normalizacijom sistolicke funkcije i nestankom perikardijalnog izljeva na kontrolnoj ehokardiografiji. Ehokardiografija s analizom globalne i segmentalne sistolicke deformacije nezamjenjiv je dijagnosticki alat u bolesnika s mioperikarditisom, komplementaran s manje dostupnom cMRI. Njome se mogu otkriti znakovi subklinicke sistolicke disfunkcije nedostupni konvencionalnoj ehokardiografiji sto utjece na terapiju i prognozu bolesnika. Kljucne rijeci: mioperikarditis, GLS, sistolicka deformacija miokarda
ISSN:0353-9466
DOI:10.20471/acc.2024.63.s1.14