Predictive value of cardiac magnetic resonance right ventricular longitudinal strain in patients with suspected myocarditis

J Cardiovasc Magn Reson. 2023 Aug 17;25(1):49. doi: 10.1186/s12968-023-00957-6.


Background: Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR.

Methods: Patients referred for CMR, meeting clinical criteria for suspected myocarditis and no other cardiomyopathy were enrolled in a dual-center register cohort study. Ejection fraction (EF), GLS and tissue characteristics were assessed in both ventricles to assess their association to first major adverse cardiovascular events (MACE) including hospitalization for heart failure (HF), ventricular tachycardia (VT), recurrent myocarditis and death.

Results: Among 659 patients (62.8% male; 48.1 ± 16.1 years), RV GLS was impaired (> - 15.4%) in 144 (21.9%) individuals, of whom 76 (58%), 108 (77.1%), 27 (18.8%) and 40 (32.8%) had impaired right ventricular ejection fraction (RVEF), impaired left ventricular ejection fraction (LVEF), RV late gadolinium enhancement (LGE) or RV edema, respectively. After a median observation time of 3.7 years, 45 (6.8%) patients were hospitalized for HF, 42 (6.4%) patients died, 33 (5%) developed VT and 16 (2.4%) had recurrent myocarditis. Impaired RV GLS was associated with MACE (HR = 1.07, 95% CI 1.04-1.10; p < 0.001), HF hospitalization (HR = 1.17, 95% CI 1.12-1.23; p < 0.001), and death (HR = 1.07, 95% CI 1.02-1.12; p = 0.004), but not with VT and recurrent myocarditis in univariate analysis. RV GLS lost its association with outcomes, when adjusted for RVEF, LVEF, LV GLS and LV LGE extent.

Conclusion: RV strain is associated with MACE, HF hospitalization and death but has neither independent nor incremental prognostic value after adjustment for RV and LV function and tissue characteristics. Therefore, assessing RV GLS in the setting of myocarditis has only limited value.

Trial registration: NCT04774549 NCT03470571.

Keywords: Cardiac magnetic resonance imaging; Feature tracking; Heart failure hospitalizations; Myocarditis; Right ventricle; Right ventricular global longitudinal strain.

MeSH terms

  • Cohort Studies
  • Contrast Media
  • Female
  • Gadolinium
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / therapy
  • Humans
  • Magnetic Resonance Spectroscopy
  • Male
  • Myocarditis* / diagnostic imaging
  • Predictive Value of Tests
  • Stroke Volume
  • Tachycardia, Ventricular*
  • Ventricular Function, Left
  • Ventricular Function, Right


  • Contrast Media
  • Gadolinium

Associated data