Gökmen AKGÜN, Eviç Zeynep BAŞAR, Ahmed Mahmud ÇIRAKOĞLU, Kadir BABAOĞLU, Yonca Akgöz ANIK
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi - 2026;12(3):227-231
Objective: Myocarditis is an inflammatory disease of the myocardium with variable clinical presentation and challenging diagnosis, particularly in children with preserved left ventricular ejection fraction. Layer-specific strain analysis using speckle-tracking echocardiography allows separate assessment of endocardial, mid-myocardial, and epicardial deformation. We aimed to evaluate layer-specific strain in pediatric patients with acute myocarditis to determine whether layer-specific deformation parameters detect subclinical myocardial dysfunction. Methods: Two-dimensional and speckle-tracking echocardiography with layer-specific strain analysis were performed. Global longitudinal strain and layer-specific longitudinal strain were measured at basal, mid-ventricular, and apical levels in endocardial, mid-myocardial, and epicardial layers. Results: Twenty-one pediatric patients with acute myocarditis (mean age 187.6 +/- 22.3 months; 17 male) and 20 age- and sex-matched healthy controls were enrolled. Patients with myocarditis had lower left ventricular ejection fraction compared to controls (63 +/- 3.4% vs 71.2 +/- 1.9%, p<0.001). Global longitudinal strain was reduced in the myocarditis group (-18.3 +/- 2.9 vs -22.2 +/- 1.3 p=<0.001). All three myocardial layers showed reduced average longitudinal strain in patients compared to controls: endocardial (-22.6 +/- 6.8 % vs -25.7 +/- 1.7 %, p=0.033), mid-myocardial (-18.1 +/- 2.9 % vs -22.4 +/- 1.8 %, p=0.040) and epicardial (-15.8 +/- 2.4 % vs -20.2 +/- 1 %, p=0.008). Conclusion: Layer-specific strain analysis detects subclinical myocardial dysfunction in pediatric myocarditis even when left ventricular ejection fraction is relatively preserved. Particularly epicardial strain impairment, reflects the known subepicardial predominance of inflammation in myocarditis. Layer-specific strain may provide incremental diagnostic value over conventional echocardiography in this population.
