Strain in children with MIS-C and acute COVID-19

Abstract

Context: Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims: We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods: TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results: Forty-five patients (34 – MIS-C and 11 – COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain ( P < 0.001), LV circumferential strain ( P < 0.001), and left atrial strain ( P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain ( P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain ( P = 0.005) and LVEF ( P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.

Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

“…Abnormal strain measurements with preserved LVEF, during the acute phase of MIS-C and in different follow-up periods, have been also described in previous studies [ 4 , 17 , 23 , 41 ]. The above findings are suggestive of subclinical myocardial injury, that can be recognized with STE with LV-GLS analysis, but not with conventional echocardiographic parameters like the LVEF [ 11 ].…”

“…These manifestations include ventricular dysfunction, valvular dysfunction, pericardial effusion, arrhythmias, conduction disorders, Coronary Artery Abnormalities (CAA) and in severe cases acute heart failure and cardiogenic shock [5,11,[14][15][16]. From the above, the most common cardiac finding in MIS-C, is Left Ventricular (LV) systolic myocardial dysfunction, which may range from subclinical myocardial injury to severe dysfunction [5,11,13,16,17]. Within days to weeks from the acute illness, the cardiac manifestations, that are described in this syndrome, usually resolve and conventional echocardiographic parameters like the LV Ejection Fraction (LVEF) return to normal, especially after the administration of effective treatment [14,18,19].…”

“…In this context, Speckle-Tracking Echocardiography (STE) has emerged as an advanced angle-independent echocardiographic technique, that assesses the myocardial strain and thereby the LV deformation, by tracing the speckle displacement during the cardiac circle [13,20,21]. In comparison with conventional Echocardiography, STE displays greater reproducibility and sensitivity in detecting subclinical and subtle LV systolic dysfunction [17,21,22]. In pediatric cardiology, STE has been used for strain assessment in various clinical settings, such as in acute myocarditis, myocardiopathy related to muscular dystrophy, cancer-therapy-induced cardiοtoxicity and Kawasaki Disease (KD) and may detect subclinical myocardial damage, in the presence of preserved LVEF [21,23].…”

Longitudinal Cardiac Evaluation of children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

“…Abnormal strain measurements with preserved LVEF, during the acute phase of MIS-C and in different follow-up periods, have been also described in previous studies [4,17,23,37]. The above ndings are suggestive of subclinical myocardial injury, that can be recognized with STE with LV-GLS analysis, but not with conventional echocardiographic parameters like the LVEF [11].…”

Unveiling post-MIS-N cardiomyopathy by longitudinal multimodality global cardiac assessment from neonatal insult to 16-month follow-up

“…Whether we should adopt a uniform, regular evaluation in every post-MIS-N heart, including strain echocardiographic study, may be considered as reported by Minocha and Krishna. [ 7 8 ] Whether continuous administration of immune suppressants like steroids early anakinra or infliximab would have altered the natural history of chronic myocarditis is a point to ponder. The presence of fibrosis in cMRI is an independent predictor of cardiac events and sudden arrhythmogenic death.…”