Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory
Yamuna Sanil1, Amrit Misra1, Raya Safa2
1Department of Pediatrics, Division of Pediatric Cardiology, Central Michigan University College of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Echocardiographic measures like left ventricular global longitudinal strain (LVGLS) and apical four-chamber peak longitudinal strain (LVA4LS) can predict adverse outcomes in children with Multisystem Inflammatory Syndrome (MIS-C). Impaired strain indicates higher risk for intensive care and prolonged hospitalization.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) linked to COVID-19 frequently involves cardiovascular complications.
- These cardiac issues can significantly influence patient prognosis and long-term health.
- Assessing ventricular function is crucial for understanding MIS-C's impact.
Purpose of the Study:
- To determine if echocardiographic measures of ventricular function are independently linked to adverse clinical outcomes in MIS-C patients.
- To investigate the association between ventricular strain and cardiac sequelae in children with MIS-C.
Main Methods:
- A longitudinal observational study involving 54 MIS-C patients and 108 controls.
- Echocardiographic assessment of ventricular function and morphometry at multiple time points.
- Analysis of clinical and echocardiographic data using regression models for risk stratification.
Main Results:
- Patients with MIS-C showed significantly decreased left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) compared to controls.
- Lower LVA4LS was associated with increased C-reactive protein, troponin levels, need for intensive care, mechanical support, and longer hospital stays.
- Impaired initial LVA4LS predicted abnormal LVA4LS at 10-week follow-up with 100% sensitivity.
Conclusions:
- Reduced LVGLS and LVA4LS at presentation are independent predictors of adverse acute clinical course in MIS-C.
- These echocardiographic parameters also indicate a risk for persistent subclinical left ventricular dysfunction at 10-week follow-up.
- LVA4LS and LVGLS can be valuable tools for identifying high-risk children with MIS-C.
Background:
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 causes significant cardiovascular involvement, which can be a determinant of clinical course and outcome. The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS-C.
Methods:
In a longitudinal observational study of 54 patients with MIS-C (mean age, 6.8 ± 4.4 years; 46% male; 56% African American), measures of ventricular function and morphometry at initial presentation, predischarge, and at a median of 3- and 10-week follow-up were retrospectively analyzed and were compared with those in 108 age- and gender-matched normal control subjects. The magnitude of strain is expressed as an absolute value. Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression.
Results:
Median left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) at initial presentation were significantly decreased in patients with MIS-C compared with the normal cohort (16.2% and 15.1% vs 22.3% and 22.0%, respectively, P < .01). Patients in the lowest LVA4LS tertile (<13%) had significantly higher C-reactive protein and high-sensitivity troponin, need for intensive care, and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile (>18.5%; P < .01). Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients, respectively. There was no mortality. In multivariate regression, only LVA4LS was associated with both the need for intensive care and length of stay. At median 10-week follow-up to date, seven of 36 patients (19%) and six of 25 patients (24%) had abnormal LVA4LS and LVGLS, respectively. Initial LVA4LS < 16.2% indicated abnormal LVA4LS at follow-up with 100% sensitivity.
Conclusion:
Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10-week follow-up, suggesting that they could be applied to identify higher risk children with MIS-C.
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