SPECKLE TRACKING ECHOCARDIOGRAPHY ANALYSIS OF GLOBAL AND REGIONAL MYOCARDIAL STRAIN IN DIAGNOSIS AND FOLLOW-UP OF THE PATIENT WITH MYOPERICARDITIS.

Abstract

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.