Strain in children with MIS-C and acute COVID-19

Prashant K Minocha; Ranjini Srinivasan; James Babb; Rakesh K Singh; Colin K L Phoon; Donna Better; Puneet Bhatla

doi:10.4103/apc.apc_93_22

Strain in children with MIS-C and acute COVID-19

Ann Pediatr Cardiol. 2022 Sep-Dec;15(5-6):459-466. doi: 10.4103/apc.apc_93_22. Epub 2023 Mar 1.

Authors

Prashant K Minocha¹, Ranjini Srinivasan^{1

2}, James Babb², Rakesh K Singh¹, Colin K L Phoon¹, Donna Better³, Puneet Bhatla^{1

2}

Affiliations

¹ Division of Pediatric Cardiology, Hassenfeld Children's Hospital at NYU Langone and New York University Grossman School of Medicine, New York, USA.
² Department of Radiology, NYU Langone Health, New York, USA.
³ Division of Pediatric Cardiology, NYU Long Island School of Medicine, Mineola, New York, USA.

Abstract

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.

Keywords: COVID-19; SARS-CoV-2; multisystem inflammatory syndrome in children; pediatrics; speckle-tracking echocardiography; strain.