Predictive value of cardiac magnetic resonance atrial and ventricular strain for adverse prognosis in patients with myocarditis: a systematic review and meta-analysis.

Authors

Meiling Li, Yongxia Zhou, Wei Zhou, Jie Ying, Dan Liu

Published in

Quantitative imaging in medicine and surgery. Volume 16. Issue 10. Pages 784. Oct 01, 2026. Epub Aug 30, 2026.

Abstract

Myocarditis refers to an inflammatory response of myocardial tissue caused by various causes. Patients with myocarditis are at high risk of adverse prognosis, defined as major adverse cardiac events (MACEs). Atrial and ventricles strain analysis using cardiac magnetic resonance (CMR) plays a crucial role in the prognostic evaluation of myocarditis. This meta-analysis provides the first comprehensive evaluation of the predictive value of atrial and ventricular strain derived from CMR for MACE in patients with myocarditis.
We searched PubMed, Embase, Web of Science, Cochrane Library, OVID Medline, Scopus, Sinomed, CNKI, Wanfang Data, VIP Database, and the search time range spans from the establishment of the database to June 2026. The level of evidence was assessed based on meta-analyses of the hazard ratios (HR) and 95% confidence intervals (CIs) of atrial and ventricular strain parameters for predicting MACE. Fixed-effect or random-effect models were used to synthesize data, with I² and sensitivity analyses for heterogeneity.
A total of 18 studies involving 3,454 participants were included, comprising 15 studies on left ventricular (LV) strain, 8 on right ventricular (RV) strain, and 8 on left atrial (LA) strain. Regarding LV myocardial strain, global longitudinal strain (GLS) (HR 1.22, 95% CI: 1.13-1.31), global circumferential strain (GCS) (HR 1.18, 95% CI: 1.10-1.28), and global radial strain (GRS) (HR 0.91, 95% CI: 0.86-0.95) all showed prognostic value for MACE in acute myocarditis. The timing of magnetic resonance (MR) examination is critical, and imaging appears to be most informative when performed within 2 weeks, or even within 1 week, after symptom onset. Regarding LA myocardial strain, Ԑs (HR 0.89, 95% CI: 0.83-0.96) and Ԑe (HR 0.92, 95% CI: 0.88-0.96) showed prognostic value for MACE in both acute and chronic myocarditis. In contrast, RV strain parameters showed limited prognostic value for MACE.
LA and LV strain derived from CMR are associated with MACEs in patients with myocarditis. Incorporating myocardial strain into the management of myocarditis may improve risk stratification.

PMID:
42861041
Bibliographic data and abstract were imported from PubMed on 12 Oct 2026.

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