Importance of Strain Echocardiography and Cardiac Magnetic Resonance for the Early Diagnosis of Myocarditis

Abstract

Introduction: Myocarditis (MC) can result from a variety of infectious and non-infectious causes, and the secondary MC due to viral infection is the most prevalent form. Acute and nonfatal MC, on the other hand, has a more indolent presentation with mortality up to 20.0% in the first year and 55.0% at 11 years based on the initial diagnosis of acute MC. The diagnostic evaluation of MC is done initially through clinical suspicion, together with non-invasive diagnostic methods. In this sense, we highlight the Echocardiography with Strain. Objective: to present the importance of the early diagnosis of myocarditis through the images obtained by the Strain Echocardiography and Cardiac Magnetic Resonance. Case report: The CBB patient, 25 years old, female, with no known diagnosis, reports that two weeks ago the patient had started upper airway infection with partial improvement after specific antimicrobial treatment. The hemogram revealed normocytic and normochromic anemia and leukocytosis with predominance of segmented. C-reactive protein was elevated and markers of myocardial ischemia were also altered. Strain echocardiography revealed segmental alterations of the endomyocardial deformation with reduction of the longitudinal Strain in the middle inferolateral and middle anterolateral segments. Cardiac magnetic resonance revealed late focal mesoepicardial enhancement, of small extension, in the midbasal inferolateral segment, suggestive of MC. Final considerations: In conclusion the study made it possible to know that the early diagnosis of myocarditis through the image obtained by the Strain Echocardiography showed the inflammatory process in the same region observed by cardiac magnetic resonance imaging. This was added to the hemogram, reactive protein, and to the markers of myocardial ischemia.