Myocardial injury following Viperidae snake envenomation significantly worsens clinical outcomes and healthcare burden, yet its early diagnostic predictors remain understudied. In this prospective cohort study from Chongqing, China, we analyzed 75 Viperidae-envenomed patients and 78 healthy controls within 24 h post-bite, assessing electrocardiographic abnormalities, cardiac biomarkers (high-sensitivity cardiac troponin I, creatine kinase), inflammatory markers (C-reactive protein), and echocardiographic right ventricular strain parameters. Results demonstrated a 14.7% incidence of myocardial injury, with 24.0% of patients exhibiting ECG abnormalities, alongside significant elevations in cardiac biomarkers and inflammatory markers (P < 0.05). The absolute values of Right Ventricular Free-wall Strain (RVFWS) and Global Longitudinal Strain (RVGLS) were significantly reduced in envenomed patients, especially in those with concomitant myocardial injury (P < 0.001). Both parameters demonstrated high diagnostic performance: RVFWS—area under the ROC curve 0.846 (95% CI 0.742–0.950); RVGLS—area under the ROC curve 0.825 (95% CI 0.700–0.950). Delayed hospitalization (> 1 h post-bite) independently predicted myocardial injury risk (OR = 1.178, P < 0.05), highlighting the critical need for rapid intervention. These findings identify RVFWS and RVGLS as sensitive early diagnostic markers for cardiac complications and underscore the importance of timely hospitalization to mitigate myocardial injury.
Chen, J., Yin, J., Zhu, D. et al. Myocardial injury within 24 hours of Viperidae snake envenomation: a prospective cohort study-a single-center experience from Chongqing, China. Intern Emerg Med (2026). https://doi.org/10.1007/s11739-026-04292-3