Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory
Michael He1, David M Leone2, Richard Frye2
1Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA. Michael.He@yale.edu.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can cause heart issues. While global strain measures improve after COVID-19 recovery, some regional segments may show persistent impairment, indicating potential long-term risks.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Imaging
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of COVID-19.
- Myocardial dysfunction is observed in acute MIS-C, but long-term subclinical injury data is limited.
Purpose of the Study:
- To assess persistent subclinical myocardial injury in children after MIS-C using deformation imaging.
- To investigate changes in left ventricular global longitudinal strain (GLS) and global circumferential strain (GCS) in the chronic phase.
Main Methods:
- Retrospective review of 22 MIS-C patients.
- Comparison of echocardiographic parameters including GLS, GCS, regional longitudinal strain (RLS), and regional circumferential strain (RCS) at acute, subacute, and chronic phases.
- Analysis of changes over time (presentation, 14-42 days, and >42 days).
Main Results:
- Mean GLS improved from -18.4% (acute) to -20.1% (chronic) (p=0.4).
- Mean GCS improved from -19.4% (acute) to -23.5% (chronic) (p=0.03).
- RLS and RCS showed recovery trends, except in the basal anterolateral segment, indicating persistent regional impairment.
Conclusions:
- While global strain parameters normalize post-MIS-C, persistent regional strain abnormalities may exist.
- These regional changes could serve as subclinical markers for future adverse cardiovascular events in pediatric patients post-MIS-C.
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14-42, and > 42 days, respectively). Mean GLS improved from - 18.4% in the acute phase to - 20.1% in the chronic phase (p = 0.4). Mean GCS improved from - 19.4% in the acute phase to - 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.
More Related Videos
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests