Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome
Enrico Piccinelli1,2, Carles Bautista-Rodriguez1,2, Jethro Herberg3,4
1Paediatric Cardiology Services, Royal Brompton Hospital, London, UK.
Insights
Multi-system inflammatory syndrome in children (MIS-C) shows transient cardiac involvement, unlike the chronic myocardial effects seen in Kawasaki disease (KD) patients with coronary abnormalities. MIS-C cardiac impairment is not linked to coronary artery issues.
Area of Science:
- Pediatric Cardiology
- Pediatric Rheumatology
- Infectious Diseases
Background:
- Multi-system inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) share overlapping clinical symptoms.
- Comparative echocardiographic data between MIS-C and KD are limited.
- Understanding cardiac involvement differences is crucial for patient management.
Approach:
- Retrospective review of echocardiography findings in MIS-C and KD patients.
- Analyzed data from MIS-C cases (April-July 2020) and KD patients with coronary abnormalities (October 2016-June 2019).
- Compared left ventricular ejection fraction and global longitudinal strain (GLS) between groups.
Key Points:
- 40 MIS-C and 45 KD patients were included.
- Left ventricle ejection fraction was normal in both groups.
- KD patients exhibited significantly lower GLS, particularly in basal segments, correlating with coronary artery involvement.
- Four MIS-C patients had coronary abnormalities; their cardiac impairment was not linked to these findings.
Conclusions:
- MIS-C is associated with transient cardiac involvement.
- KD patients with coronary abnormalities show subtle, chronic myocardial involvement.
- The mechanism of cardiac impairment in MIS-C differs from KD and is likely not related to coronary artery abnormalities.
Background:
Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking.
Methods:
We reviewed echocardiography findings of all multi-system inflammatory syndrome cases between 1st April and 31st July, 2020 and typical Kawasaki disease patients with coronary arteries abnormalities consecutively followed between 1st October, 2016 and June 30th, 2019.
Results:
We included 40 multi-system inflammatory syndrome children (25 males, 62.5%) and 45 Kawasaki disease patients (31 males, 68.9%) at a mean age of 6.4 years old and 8 years old, respectively. Four out of 40 multi-system inflammatory syndrome children had coronary arteries abnormalities. Left ventricle ejection fraction was normal in both groups. Global longitudinal strain was normal although Kawasaki disease group had significantly lower values (-20.0 versus -21.7%; p = 0.02). Basal segments were the most affected in Kawasaki disease patients with significant differences in the basal anterior, anterolateral, and anteroseptal strain: -18.2 versus -23.0% (p = 0.002), -16.7 versus -22.0% (p < 0.001), -16.7 versus -19.5% (p = 0.034), respectively. The basal anterolateral and anteroseptal segments in Kawasaki disease patients were the only ones with an absolute reduction of longitudinal strain (-16.7% both) consistent with the greater left main coronary involvement in this cohort.
Conclusions:
Our findings are consistent with the transient cardiac involvement in multi-system inflammatory syndrome, as opposed to the subtle and chronic myocardial involvement in Kawasaki disease children with coronary arteries abnormalities. We speculate that the mechanism of cardiac impairment in the few multi-system inflammatory syndrome children with reduced global longitudinal strain is not related to coronary arteries abnormalities.
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