Role of Echocardiography in Diagnosing and Managing Myocarditis

Diagnostic Value in Myocarditis

The European Society of Cardiology recommends echocardiography for evaluation of chest pain in patients with suspected myocarditis, pericarditis, or pulmonary embolism 1, 2, 3
Echocardiography findings in acute myocarditis may include left ventricular systolic and diastolic dysfunction, regional wall motion abnormalities, unspecific changes in image texture, intracardiac thrombi, secondary mitral and/or tricuspid regurgitation, co-existent pericardial involvement, and ventricular wall thickening due to interstitial edema 1, 4

Speckle tracking imaging can detect myocardial inflammation by reduction in global systolic longitudinal strain (LV-GLS) and strain rate, which correlates with intramyocardial inflammation in endomyocardial biopsies 1, 3, 4
Real-time myocardial contrast echocardiography can detect perfusion defects, including areas of necrosis and inflammation that result in myocardial perfusion defects 1, 4

Echocardiography cannot accurately differentiate myocardial edema from wall hypertrophy, and speckle tracking cannot differentiate inflammation-induced strain reduction from other causes 1, 3
The American College of Cardiology notes that echocardiography has a limited role in direct visualization of inflammation compared to cardiac MRI 5

Echocardiography is useful for monitoring significant changes in wall motion during the course of disease and detecting complications such as intracardiac thrombi and pericardial effusion 4, 5

The American College of Cardiology recommends using echocardiography as part of a comprehensive diagnostic approach to rule out other causes of heart failure and complement cardiac MRI 5
Transesophageal echocardiography (TOE) may be indicated when transthoracic echocardiography (TTE) studies are non-diagnostic 1, 3