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European Journal of Echocardiography Advance Access published online on November 24, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep183
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Acute myocarditis: can novel echocardiographic techniques assist with diagnosis?

Luis Afonso1,2,*, Pawan Hari1, Victor Pidlaoan1, Ashok Kondur1,2, Sony Jacob1,2 and Vipin Khetarpal1,2

1 Division of Internal Medicine, Wayne State University, Detroit, MI, USA
2 Internal Medicine, Division of Cardiology, Wayne State University, Detroit, MI 48201, USA

Received 27 June 2009; accepted after revision 21 October 2009.

* Corresponding author. Tel: +1 313 745 2620, Email: lafonso{at}med.wayne.edu


  Abstract

Two-dimensional echocardiography has historically played a limited role in the diagnosis of acute myocarditis because of a lack of specific diagnostic features. The emergence of novel echocardiographic modalities such as strain and myocardial perfusion imaging have greatly augmented the scope of echocardiography, permitting the assessment of myocardial contractility, blood flow, and microvascular integrity. However, the application of these cutting-edge techniques in the diagnosis of acute myocarditis is still at a nascent stage. We present a case of acute myocarditis where echo-based strain imaging/mapping and real-time myocardial contrast echocardiography enabled the detection of regional contractile and perfusion abnormalities, not otherwise apparent with conventional echocardiography. These findings and the final diagnosis were later confirmed by cardiac magnetic resonance imaging. This case highlights the potential utility of novel echocardiographic techniques in the diagnostic workup of acute myocarditis and underscores the need for prospective studies to assess the sensitivity and specificity of these newer technologies. To our knowledge, this is the first report of a multimodality echocardiographic approach towards the diagnosis of myocarditis.

Keywords: Two-dimensional strain imaging; Speckle tracking; Myocardial perfusion echocardiography


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