Pediatric myocarditis often presents with heterogeneous symptoms, which can delay diagnosis. Although cardiac magnetic resonance (CMR) remains the imaging reference standard, limited access may restrict routine use. A systematic review published in Echocardiography evaluated whether strain echocardiography may support the diagnosis of suspected pediatric myocarditis.

A search of MEDLINE, Embase, and Scopus through July 2025 identified seven eligible studies, including three case-control studies (myocarditis n = 119; controls n = 50) and four cohort studies (n = 101).

Compared with controls, the pooled mean difference in left ventricular ejection fraction (LVEF) was −4.3% (95% CI, −10.5% to 1.9%), while left ventricular global longitudinal strain (LV-GLS) showed a larger reduction of −5.2% (95% CI, −7.7% to −2.8%). Mean pooled LVEF in myocarditis was 61.9%, and mean LV-GLS was −17.0%.

Subgroup analysis showed differences in mean LVEF according to normal versus abnormal LVEF status (p = .042), whereas LV-GLS remained similar across LVEF categories (p = .583). Studies that included CMR reported good concordance between strain echocardiography and CMR-positive myocardial injury.

These findings suggest strain echocardiography may help identify myocardial dysfunction in suspected pediatric myocarditis, particularly when CMR is not readily available.