Rolfs Nele, Huber Cynthia, Opgen-Rhein Bernd, Altmann Isabell, Anderheiden Felix, Hecht Tobias, Fischer Marcus, Wiegand Gesa, Reineker Katja, Voges Inga, Kiski Daniela, Frede Wiebke, Boehne Martin, Khedim Malika, Messroghli Daniel, Klingel Karin, Schwarzkopf Eicke, Pickardt Thomas, Schubert Stephan, Lunze Fatima I, Seidel Franziska
Department of Congenital Heart Disease-Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany.
Biomedicines. 2024 Oct 16;12(10):2369. doi: 10.3390/biomedicines12102369.
Risk assessment in pediatric myocarditis is challenging, particularly when left ventricular ejection fraction (LVEF) is preserved. This study aimed to evaluate LV myocardial deformation using speckle-tracking echocardiography (STE)-derived longitudinal +strain (LS) and assessed its diagnostic and prognostic value in children with myocarditis. Retrospective STE-derived layer-specific LV LS analysis was performed on echocardiograms from patients within the multicenter, prospective registry for pediatric myocarditis "MYKKE". Age- and sex-adjusted logistic regression and ROC analysis identified predictors of cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, atrioventricular blockage III°) and major adverse cardiac events (MACE: need for mechanical circulatory support (MCS), cardiac transplantation, and/or cardiac death). Echocardiograms from 175 patients (median age 15 years, IQR 7.9-16.5 years; 70% male) across 13 centers were included. Cardiac arrhythmias occurred in 36 patients (21%), and MACE in 28 patients (16%). Impaired LV LS strongly correlated with reduced LVEF (r > 0.8). Impaired layer-specific LV LS, reduced LVEF, LV dilatation, and increased BSA-indexed LV mass, were associated with the occurrence of MACE and cardiac arrhythmias. In patients with preserved LVEF, LV LS alone predicted cardiac arrhythmias ( < 0.001), with optimal cutoff values of -18.0% for endocardial LV LS (sensitivity 0.69, specificity 0.94) and -17.0% for midmyocardial LV LS (sensitivity 0.81, specificity 0.75). In pediatric myocarditis, STE-derived LV LS is not only a valuable tool for assessing systolic myocardial dysfunction and predicting MACE but also identifies patients at risk for cardiac arrhythmias, even in the context of preserved LVEF.
小儿心肌炎的风险评估具有挑战性，尤其是当左心室射血分数（LVEF）保持正常时。本研究旨在使用斑点追踪超声心动图（STE）衍生的纵向应变（LS）评估左心室心肌变形，并评估其在心肌炎患儿中的诊断和预后价值。对多中心前瞻性小儿心肌炎注册研究“MYKKE”中患者的超声心动图进行回顾性STE衍生的层特异性左心室LS分析。年龄和性别调整的逻辑回归和ROC分析确定了心律失常（室性心动过速、心室颤动、三度房室传导阻滞）和主要不良心脏事件（MACE：需要机械循环支持（MCS）、心脏移植和/或心源性死亡）的预测因素。纳入了来自13个中心的175例患者（中位年龄15岁，IQR 7.9 - 16.5岁；70%为男性）的超声心动图。36例患者（21%）发生心律失常，28例患者（16%）发生MACE。左心室LS受损与LVEF降低密切相关（r > 0.8）。层特异性左心室LS受损、LVEF降低、左心室扩张以及体表面积指数化的左心室质量增加与MACE和心律失常的发生相关。在LVEF保持正常的患者中，单独的左心室LS可预测心律失常（< 0.001），心内膜左心室LS的最佳截断值为 -18.0%（敏感性0.69，特异性0.94），心肌中层左心室LS的最佳截断值为 -17.0%（敏感性0.81，特异性0.75）。在小儿心肌炎中，STE衍生的左心室LS不仅是评估收缩期心肌功能障碍和预测MACE的有价值工具，而且还能识别心律失常风险患者，即使在LVEF保持正常的情况下也是如此。
