Speckle-tracking and conventional echocardiography in MIS-C: tracking cardiac involvement and recovery
Nima Mehdizadegan1,2, Sajedeh Omidbakhsh3, Eslam Shorafa4
1Department of Pediatrics, Division of Pediatric Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can affect the heart, but cardiac function, including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), typically normalizes within three months. Long-term monitoring is advised for persistent abnormalities.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious COVID-19 complication.
- Cardiac involvement is common in MIS-C, but its long-term impact on myocardial function is not fully understood.
- This study investigates mid-term cardiac function in children with and without cardiac involvement during MIS-C.
Purpose of the Study:
- To evaluate mid-term cardiac function in children with MIS-C.
- To compare cardiac function between MIS-C patients with and without cardiac involvement and healthy controls.
- To assess the recovery of myocardial abnormalities over a three-month period.
Main Methods:
- A case-control study involving 90 children (30 MIS-C with cardiac involvement, 30 MIS-C without cardiac involvement, 30 healthy controls).
- Transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) were used to measure left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS).
- Cardiac function parameters were assessed at diagnosis and at three months post-diagnosis.
Main Results:
- Children with MIS-C and cardiac involvement showed elevated inflammatory markers (ferritin, C-reactive protein) and troponin positivity.
- Baseline LVEF and GLS were significantly reduced in the cardiac involvement group compared to controls, particularly in the basal segment.
- By three months, LVEF and GLS normalized in most MIS-C patients, with resolution of heart failure and coronary artery abnormalities; only two cases had persistent mild left ventricular dilation.
Conclusions:
- Cardiac dysfunction associated with MIS-C is largely reversible within three months.
- Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) return to normal levels in most affected children.
- Despite overall recovery, a subset of patients may experience persistent myocardial abnormalities, necessitating ongoing cardiac monitoring.
Background:
Multisystem inflammatory syndrome in children (MIS-C), a complication of COVID-19, is frequently associated with cardiac involvement. Although most affected children recover, the extent and duration of myocardial abnormalities remain uncertain. This study evaluates mid-term cardiac function in MIS-C patients, with and without cardiac involvement, using transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE).
Methods:
This case-control study (2022-2023) included 90 children: 30 with MIS-C and cardiac involvement, 30 with MIS-C without cardiac involvement, and 30 healthy controls. TTE and STE were used to assess left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) at diagnosis and at three months, comparing outcomes across groups.
Results:
The cardiac involvement group exhibited significantly elevated ferritin and C-reactive protein levels (P = 0.006 and P = 0.017, respectively) and a higher prevalence of troponin positivity (56.67% vs. 20%, P = 0.009). At baseline, these patients had markedly reduced LVEF (56.5 ± 4.3) and GLS (-21.6 ± 3.21) compared to healthy controls (LVEF: 68.2 ± 5.21; GLS: -24.8 ± 1.48; both P < 0.001). Notably, the basal segment showed significant longitudinal strain reduction (-18.75 ± 3.89 vs. -23.58 ± 0.27, P = 0.027), while differences in the apical and mid segments were not significant. By three months, LVEF (69 ± 4.21, P = 0.53) and GLS (-24.13 ± 2.39, P = 0.17) normalized. Heart failure and coronary artery brightness resolved in all affected patients, and most structural abnormalities improved; only two cases exhibited persistent mild left ventricular dilation. Regional strain analysis at follow-up revealed values comparable to those of healthy controls across all segments.
Conclusion:
Cardiac dysfunction in MIS-C largely resolves within three months, with LVEF and GLS returning to normal. However, persistent myocardial abnormalities in a few cases highlight the need for long-term cardiac monitoring to detect and manage potential sequelae.
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