Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-21T12:10:31.310Z Has data issue: false hasContentIssue false
  • English
  • Français

Is strain echocardiography a more sensitive indicator of myocardial involvement in patients with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2?

Part of: Echocardiography

Published online by Cambridge University Press:  24 March 2022

Eviç Z. Başar Open the ORCID record for Eviç Z. Başar [Opens in a new window] ,
Emre Usta ,
Gökmen Akgün ,
Hüseyin S. Güngör ,
Hafize E. Sönmez  and
Kadir Babaoğlu Open the ORCID record for Kadir Babaoğlu [Opens in a new window]
Eviç Z. Başar*
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
Emre Usta
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
Gökmen Akgün
Affiliation:
Department of Pediatric Cardiology, Faculty of Health Science, Darıca Farabi Training and Research Hospital, Kocaeli, Turkey
Hüseyin S. Güngör
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
Hafize E. Sönmez
Affiliation:
Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
Kadir Babaoğlu
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
*
Author for correspondence: Asist. Prof. Dr E. Z. Başar, Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. Tel: +905074630082; Fax: +902623037003. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aim of the study was to evaluate the early myocardial dysfunction detected by strain echocardiography in children with multisystem inflammatory syndrome related to SARS-CoV-2 infection.

Methods:

This cross-sectional study was conducted with 47 patients diagnosed with MIS-C and 32 healthy age- and gender-matched children. All patients underwent two-dimensional, colour, pulsed, and tissue Doppler, and 2D speckle tracking echocardiography examination at admission, 2 weeks, and 2 months after discharge. The MIS-C patient group was compared with the control group. Echocardiographic changes in MIS-C patients during follow-up were evaluated.

Results:

Of 47 patients, 30 (63.8%) were male and 17 (36.2%) were female. The mean age at diagnosis was 9.1 ± 4.3 (1.25–17) years. At admission, 25 patients had abnormal findings on conventional echocardiography. Among them, eight patients had left ventricular systolic dysfunction. Ejection fraction and fractional shortening were significantly lower in the patient group at admission compared to controls (p = 0.013, p = 0.010, respectively). While the ejection fraction was <55% in eight patients, and global longitudinal strain was lower than −2SD in 29 patients at admission. Global longitudinal strain z-score <−2SD persisted in 13 patients at 2-month follow-up. Ejection fraction increased above 55% in 3.42 ± 0.53 days in 7 of 8 patients with left ventricular systolic dysfunction, ejection fraction was 51% at discharge in one patient, and left ventricular systolic dysfunction persisted at the 6-month of follow-up.

Conclusion:

These results confirmed that speckle tracking echocardiography is more likely to detect subclinical myocardial damage compared to conventional echocardiography. In addition, it is a valuable method for follow-up in this patient group.

Keywords

Multisystem Inflammatory Syndrome related to SARS-CoV-2MIS-Cmyocarditisspeckle tracking echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1657 - 1667
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Retrieved May 14, 2020, from https://emergency.cdc.gov/han/2020/han00432.asp Google Scholar
Ramcharan, T, Nolan, O, Lai, CY, et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr Cardiol 2020; 41: 1391–1401.CrossRefGoogle Scholar
Sood, M, Sharma, S, Sood, I, Sharma, K, Kaushik, A. Emerging evidence on multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection: a systematic review with meta-analysis. SN Compr Clin Med 2021; 3: 38–47.CrossRefGoogle ScholarPubMed
Capone, CA, Subramony, A, Sweberg, T, et al. Characteristics, cardiac involvement, and outcomes of multisystem inflammatory syndrome of childhood associated with severe acute respiratory syndrome coronavirus 2 infection. J Pediatr 2020; 224: 141–145.CrossRefGoogle ScholarPubMed
Waltuch, T, Gill, P, Zinns, LE, Whitney, R, et al. Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department. Am J Emerg Med 2020; 38: 2246 e3–e6.CrossRefGoogle ScholarPubMed
Lan, J, Ge, J, Yu, J, et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor. Nature 2020; 581: 215–220.CrossRefGoogle ScholarPubMed
Haghighi Aski, B, Manafi Anari, A, Abolhasan Choobdar, F, Zareh Mahmoudabadi, R, Sakhaei, M. Cardiac abnormalities due to multisystem inflammatory syndrome temporally associated with Covid-19 among children: a systematic review and meta-analysis. Int J Cardiol Heart Vasc 2021; 33: 100764.Google ScholarPubMed
Grimaud, M, Starck, J, Levy, M, et al. Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Ann Intensive Care 2020; 10: 69.CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324: 259–269.CrossRefGoogle ScholarPubMed
Chinali, M, Franceschini, A, Ciancarella, P, et al. Echocardiographic two-dimensional speckle tracking identifies acute regional myocardial edema and sub-acute fibrosis in pediatric focal myocarditis with normal ejection fraction: comparison with cardiac magnetic resonance. Sci Rep 2020; 10: 11321.CrossRefGoogle ScholarPubMed
Theocharis, P, Wong, J, Pushparajah, K, et al. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2020 Google Scholar
Kobayashi, R, Dionne, A, Ferraro, A, et al. Detailed assessment of left ventricular function in multisystem inflammatory syndrome in children using strain analysis. CJC Open 2021; 3: 880–887.CrossRefGoogle ScholarPubMed
WHO. Multisystem Inflammatory Syndrome in Children and Adolescents with Covid-19: Scientific Brief. World Health Organization, Geneva, Switzerland, 2020. Retrieved May 15, 2020, from https://apps.who.int/iris/handle/10665/332095 Google Scholar
Dasgupta, S, Iannucci, G, Mao, C, Clabby, M, Oster, ME. Myocarditis in the pediatric population: a review. Congenit Heart Dis 2019; 14: 868–877.CrossRefGoogle ScholarPubMed
Başar, EZ, Sönmez, HE, Öncel, S, Yetimakman, AF, Babaoğlu, K. Multisystemic inflammatory syndrome in children associated with COVID-19: a single center experience in Turkey. Turk Arch Pediatr 2021; 56: 192–199.CrossRefGoogle ScholarPubMed
Lang, RM, Badano, LP, Mor-Avi, V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 233–270.CrossRefGoogle ScholarPubMed
McCrindle, BW, Rowley, AH, Newburger, JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals From the American Heart Association. Circulation 2017; 135: e927–e999. Published correction appears in Circulation 2019; 140: e181–e184.CrossRefGoogle ScholarPubMed
Dallaire, F, Slorach, C, Bradley, T, et al. Pediatric reference values and Z score equations for left ventricular systolic strain measured by two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 2016; 29: 786–793.e8.CrossRefGoogle ScholarPubMed
Omar, AM, Vallabhajosyula, S, Sengupta, PP. Left ventricular twist and torsion: research observations and clinical applications. Circ Cardiovasc Imaging 2015; 8: e003029.CrossRefGoogle ScholarPubMed
Dufort, EM, Koumans, EH, Chow, EJ, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020; 383: 347–358.CrossRefGoogle ScholarPubMed
Verdoni, L, Mazza, A, Gervasoni, A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–1778.CrossRefGoogle Scholar
Dolhnikoff, M, Ferreira Ferranti, J, de Almeida Monteiro, RA, et al. SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome. Lancet Child Adolesc Health 2020; 4: 790–794. Published correction appears in Lancet Child Adolesc Health 2020; 4: e39.CrossRefGoogle ScholarPubMed
Feldstein, LR, Tenforde, MW, Friedman, KG, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA 2021; 325: 1074–1087.CrossRefGoogle ScholarPubMed
Valverde, I, Singh, Y, Sanchez-de-Toledo, J, et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021; 143: 21–32.CrossRefGoogle ScholarPubMed
Matsubara, D, Kauffman, HL, Wang, Y, et al. Echocardiographycardiographycardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol 2020; 76: 1947–1961.CrossRefGoogle ScholarPubMed
Tei, C, Ling, LH, Hodge, DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366.Google ScholarPubMed
Okawa, M, Kitaoka, H, Matsumura, Y, et al. Functional assessment by myocardial performance index (Tei index) correlates with plasma brain natriuretic peptide concentration in patients with hypertrophic cardiomyopathy. Circ J 2005; 69: 951–957.CrossRefGoogle ScholarPubMed
Bruch, C, Schmermund, A, Marin, D, et al. Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J 2000; 21: 1888–1895.CrossRefGoogle ScholarPubMed
Ajami, G, Borzouee, M, Amoozgar, H, et al. Evaluation of myocardial function using the Tei index in patients with Kawasaki disease. Cardiol Young 2010; 20: 44–48.CrossRefGoogle ScholarPubMed
Song, ES, Yoon, S, Cho, JH, et al. Serial evaluation of myocardial function using the myocardial performance index in Kawasaki disease. World J Pediatr 2018; 14: 259–268.CrossRefGoogle ScholarPubMed
Khoo, NS, Smallhorn, JF, Atallah, J, Kaneko, S, Mackie, AS, Paterson, I. Altered left ventricular tissue velocities, deformation and twist in children and young adults with acute myocarditis and normal ejection fraction. J Am Soc Echocardiogr 2012; 25: 294–303.CrossRefGoogle Scholar
Xu, QQ, Ding, YY, Lv, HT, et al. Evaluation of left ventricular systolic strain in children with Kawasaki disease. Pediatr Cardiol 2014; 35: 1191–1197.CrossRefGoogle ScholarPubMed
Kayabey, Ö., Tuncer, T, Deveci, M, Başar, EZ, Babaoğlu, K. Is there myocardial involvement in children with long-term follow-up for Kawasaki disease? A study based on two-dimensional speckle tracking echocardiography. Turk Arch Pediatr 2021; 56: 44–50.Google ScholarPubMed
Gaitonde, M, Ziebell, D, Kelleman, MS, et al. COVID-19-related multisystem inflammatory syndrome in children affects left ventricular function and global strain compared with Kawasaki disease. J Am Soc Echocardiogr 2020; 33: 1285–1287.CrossRefGoogle ScholarPubMed
Sanil, Y, Misra, A, Safa, R, et al. Echocardiographic indicators associated with adverse clinical course and cardiac sequelae in multisystem inflammatory syndrome in children with coronavirus disease 2019. J Am Soc Echocardiogr 2021; 34: 862–876.CrossRefGoogle ScholarPubMed
McMurray, JC, May, JW, Cunningham, MW, Jones, OY. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis-a critical review of its pathogenesis and treatment. Front Pediatr 2020; 8: 626182.CrossRefGoogle Scholar
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429–436.CrossRefGoogle ScholarPubMed
Supplementary material: File

Başar et al. supplementary material

Table S2
Download Başar et al. supplementary material(File)
File 18.8 KB
Supplementary material: File

Başar et al. supplementary material

Table S1
Download Başar et al. supplementary material(File)
File 18 KB
Supplementary material: File

Başar et al. supplementary material

Table S3
Download Başar et al. supplementary material(File)
File 15.4 KB