To evaluate longitudinal systolic function in patients with myocarditis, its correlation with cardiac magnetic resonance (CMR) features, and its predictive value in functional recovery and arrhythmias onset during follow-up (FU) on optimized medical therapy (OMT). Patients with acute myocarditis, confirmed through CMR criteria, and age- and sex-matched healthy controls were enrolled. Two-dimensional (2D) transthoracic echocardiography, including speckle tracking analysis, was performed at admission and after 6 months of FU. Patients of myocarditis group also underwent 24 h ECG Holter monitoring during FU. 115 patients with myocarditis (mean age 41 ± 17, 70% males) and 70 healthy subjects were enrolled. Global longitudinal strain (GLS) and sub-epicardial strain were markedly lower in the myocarditis group than in controls (mean GLS%: − 14.1 ± 5.1 vs − 23.1 ± 3.6, p < 0.001). A strong positive correlation between total scar burden (TSB) on CMR and baseline LV GLS was found (r = 0.67, p < 0.0001). GLS improved after 6 months of FU in myocarditis on OMT (mean GLS%: − 14.1 ± 5.1 vs − 16.5 ± 4.8, p < 0.01). By bivariate correlation analysis, baseline LVEF, GLS, and TSB were all associated with LVEF at 6 months of FU. Moreover, by multivariable linear regression analysis, these parameters confirmed to be independent predictors of functional recovery at 6 months (LVEF β 0.38, p < 0.01; GLS β − 0.35, p < 0.01; total scar burden β − 0.52, p < 0.0001). Segmental peak systolic strain was significantly different between segments with and without late gadolinium enhancement on CMR (− 13.2 ± 3.1% vs − 18.1 ± 3.5%, p < 0.001). A segmental strain of − 12% identified scar with a sensitivity of 79% and a specificity of 84% (AUC = 0.91; 95% CI 0.73–0.97; p < 0.001). In addition, baseline LV GLS in myocarditis resulted predictive of non-sustained ventricular tachycardias (cut-off value > − 12%; sensitivity84%; specificity74.4%; AUC = 0.75). Parameters of myocardial longitudinal deformation are importantly associated with the presence of a scar on CMR and are predictors of functional outcome and ventricular arrhythmias in patients with acute myocarditis. Their assessment during ultrasound examination should be considered to get more information about the prognosis and risk stratification of this subset of patients.

评估心肌炎患者的纵向收缩功能、其与心脏磁共振 (CMR) 特征的相关性，以及其在优化药物治疗 (OMT) 的随访 (FU) 期间功能恢复和心律失常发作的预测价值。纳入通过 CMR 标准确认的急性心肌炎患者以及年龄和性别匹配的健康对照。在入院时和 FU 6 个月后进行二维 (2D) 经胸超声心动图检查，包括斑点跟踪分析。心肌炎组患者在 FU 期间也接受了 24 h 心电图 Holter 监测。招募了 115 名心肌炎患者（平均年龄 41 ± 17，70% 为男性）和 70 名健康受试者。心肌炎组的整体纵向应变 (GLS) 和心外膜下应变明显低于对照组（平均 GLS%：- 14.1 ± 5.p  < 0.001)。发现 CMR 上的总疤痕负担 (TSB) 与基线 LV GLS 之间存在强正相关 ( r  = 0.67, p  < 0.0001)。OMT 心肌炎患者 FU 6 个月后 GLS 改善（平均 GLS%：- 14.1 ± 5.1 vs - 16.5 ± 4.8，p  < 0.01）。通过双变量相关分析，基线 LVEF、GLS 和 TSB 均与 FU 6 个月时的 LVEF 相关。此外，通过多变量线性回归分析，这些参数证实是 6 个月时功能恢复的独立预测因子（LVEF β 0.38，p  < 0.01；GLS β - 0.35，p  < 0.01；总瘢痕负荷β - 0.52，p < 0.0001)。在 CMR 上，有和没有晚期钆增强的节段之间的节段峰值收缩应变显着不同（- 13.2 ± 3.1% vs - 18.1 ± 3.5%，p  < 0.001）。− 12% 的节段性应变以 79% 的敏感性和 84% 的特异性识别出瘢痕（AUC = 0.91；95% CI 0.73–0.97；p < 0.001)。此外，心肌炎中的基线 LV GLS 可预测非持续性室性心动过速（临界值 > - 12%；敏感性 84%；特异性 74.4%；AUC = 0.75）。心肌纵向变形参数与 CMR 上瘢痕的存在重要相关，并且是急性心肌炎患者功能结果和室性心律失常的预测因子。应考虑在超声检查期间对其进行评估，以获得有关这部分患者的预后和风险分层的更多信息。