Key result
Children with MIS-C and acute COVID-19 exhibited significantly decreased left ventricular longitudinal strain compared to healthy controls (P<0.001 and P=0.028, respectively).
Why the study?
Cardiac injury has been described in acute COVID-19 and MIS-C, and echocardiographic strain is a sensitive measure of systolic function, prompting characterization of strain findings on initial presentation and follow-up.
Does echocardiographic strain analysis detect subtle myocardial dysfunction in children with MIS-C and acute COVID-19 compared to healthy controls?
Observational (n=45)
No
Does echocardiographic strain analysis detect subtle myocardial dysfunction in children with MIS-C and acute COVID-19 compared to healthy controls?
Echocardiographic strain analysis can detect subtle myocardial dysfunction in children with MIS-C and acute COVID-19, even when traditional left ventricular ejection fraction is preserved.
Strain imaging may detect subclinical LV dysfunction in children with MIS-C or COVID-19 despite preserved LVEF; hypothesis-generating and requires prospective validation.
Context: Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims: We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods: TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results: Forty-five patients (34 – MIS-C and 11 – COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain ( P < 0.001), LV circumferential strain ( P < 0.001), and left atrial strain ( P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain ( P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain ( P = 0.005) and LVEF ( P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.
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Minocha et al. (2022) conducted an observational in MIS-C and acute COVID-19 (n=45). MIS-C and acute COVID-19 vs. Age-matched healthy controls was evaluated on Left ventricular longitudinal strain (p=<0.001). Children with MIS-C and acute COVID-19 exhibited significantly decreased left ventricular longitudinal strain compared to healthy controls (P<0.001 and P=0.028, respectively).
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