Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT, USA.
Pediatr Cardiol. 2022 Apr;43(4):844-854. doi: 10.1007/s00246-021-02796-7. Epub 2022 Jan 7.
Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14-42, and > 42 days, respectively). Mean GLS improved from - 18.4% in the acute phase to - 20.1% in the chronic phase (p = 0.4). Mean GCS improved from - 19.4% in the acute phase to - 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.
儿童多系统炎症综合征（MIS-C）是儿童 2019 年冠状病毒病（COVID-19）的最严重后遗症之一。新兴文献已经描述了 MIS-C 患者在急性期使用传统和二维斑点追踪超声心动图的心肌功能障碍。然而，关于恢复后亚临床心肌损伤持续存在的数据有限。我们旨在通过变形成像检测这些变化，假设尽管二维超声心动图评估的心室功能参数正常化，但左心室整体纵向应变（GLS）和环向应变（GCS）在慢性期仍会受损。对 22 例 MIS-C 患者进行了回顾性单机构研究。比较了收缩分数、GLS 和 GCS 以及局部纵向应变（RLS）和环向应变（RCS）在急性期、亚急性期和慢性期（分别为就诊时、14-42 天和>42 天）的变化。GLS 的平均值从急性期的-18.4%改善到慢性期的-20.1%（p=0.4）。GCS 的平均值从急性期的-19.4%改善到慢性期的-23.5%（p=0.03）。急性时 RCS 和 RLS 受损，慢性期有恢复趋势，但基底前外侧节段除外。在我们对 MIS-C 患者的纵向研究中，GLS 和 GCS 在急性期较低，与传统指标所示的左心室功能障碍一致。此外，随着功能的全面恢复，GLS 和 GCS 也恢复正常。然而，一些节段的应变值仍然较低，这可能是未来不良事件的一个重要亚临床标志物。
