Key result
Kawasaki disease with coronary abnormalities is linked to lower global longitudinal strain than MIS-C.
Why the study?
Multi-system inflammatory syndrome in children and Kawasaki disease share overlapping clinical features, but comparative echocardiographic studies are lacking.
Are there differences in segmental and global longitudinal strain between children with multi-system inflammatory syndrome and those with Kawasaki disease?
Cohort (n=85)
Are there differences in segmental and global longitudinal strain between children with multi-system inflammatory syndrome and those with Kawasaki disease?
Absolute Event Rate: -20% vs -21.7%
p-value: p=0.02
Echocardiographic strain analysis reveals that Kawasaki disease with coronary abnormalities involves subtle, chronic myocardial impairment primarily in basal segments, whereas MIS-C shows transient cardiac involvement with preserved or less impaired strain.
KD with CAA may indicate subtle chronic impairment versus transient MIS-C effects; hypothesis-generating for strain monitoring, needs prospective validation.
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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Piccinelli et al. (2022) conducted a cohort in Multi-system inflammatory syndrome in children and Kawasaki disease (n=85). Kawasaki disease vs. Multi-system inflammatory syndrome was evaluated on Global longitudinal strain (p=0.02). Kawasaki disease patients with coronary artery abnormalities had significantly lower global longitudinal strain than children with multi-system inflammatory syndrome (-20.0% vs -21.7%; p=0.02).
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