CMR-Derived Atrial and Ventricular Strain Predict Outcomes in Acute Pericarditis

Overview

This preliminary study evaluated the prognostic value of atrial and ventricular strain parameters derived from cardiovascular magnetic resonance (CMR) in patients with acute pericarditis. The findings suggest that CMR feature tracking of left atrial and ventricular strain may provide important predictive information on clinical outcomes beyond conventional imaging.

Background

Acute pericarditis involves inflammation of the pericardial layers with diverse causes including infections and autoimmune diseases. While mortality has decreased, morbidity remains significant, necessitating accurate diagnosis and management. Current ESC guidelines recommend diagnosis based on clinical symptoms, ECG, and echocardiography, with CMR used to assess myocardial involvement and exclude ischemia. CMR offers high-resolution tissue characterization and can detect pericardial inflammation and myocardial changes, with feature tracking enabling quantitative assessment of myocardial strain without additional contrast.

Data Highlights

The study retrospectively included patients with a first episode of acute pericarditis who underwent CMR within 7 days of symptom onset. CMR scans were performed on a 1.5-T scanner with cine imaging and T1 mapping. Feature tracking analysis measured peak global longitudinal, radial, and circumferential strain of the left ventricle and longitudinal strain of the left atrium using dedicated software. Exclusion criteria included prior myocardial infarction, cardiomyopathy, atrial fibrillation, and chronic or recurrent pericarditis.

Key Findings

• CMR feature tracking enabled sensitive quantification of left atrial and ventricular strain in acute pericarditis patients without additional contrast administration.
• Positive late gadolinium enhancement (LGE) in pericardial layers was associated with increased risk of pericarditis recurrence (OR 8.94, p = 0.008).
• Left atrial and left ventricular strain parameters showed potential as prognostic markers for clinical outcomes in acute pericarditis.
• Abbreviated CMR protocols focusing on strain analysis may provide practical advantages in clinical settings by avoiding contrast media.
• This study is the first to investigate the predictive value of atrial and ventricular strain via CMR in acute pericarditis patients.

Clinical Implications

Incorporating CMR-derived atrial and ventricular strain measurements into the diagnostic workup of acute pericarditis could enhance risk stratification and guide management decisions. The ability to obtain prognostic information from non-contrast CMR protocols may facilitate broader clinical application and reduce patient burden. Early identification of patients at higher risk for adverse outcomes could improve monitoring and therapeutic strategies.

Conclusion

CMR feature tracking of atrial and ventricular strain represents a promising tool for predicting clinical outcomes in acute pericarditis. Further studies are warranted to validate these findings and integrate strain analysis into routine clinical practice.

References

1. Conte et al 2022 -- Prognostic value of late gadolinium enhancement in pericarditis
2. ESC Guidelines 2015 -- Diagnosis and management of pericardial diseases