Heart failure & cardiomyopathies
2D Speckle Tracking Strain Echocardiography in Multisystem Inflammatory Syndrome in Children: A Multicenter Analysis From the MUSIC Study
Authors' conclusion
About half of patients with MIS-C had abnormal LV strain during hospitalization. 4CH-LVLS, mid-LVCS, the most abnormal strain Z score, and early diastolic longitudinal strain rate at admission were independently associated with in-hospital adverse cardiovascular outcome. These data may help early characterization and prognostication in MIS-C.
Study context
- Population
- Hospitalized patients with multisystem inflammatory syndrome in children (MIS-C) (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab
- Participants
- 349 patients
- Exposure
- Association between left ventricular (LV) strain parameters and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant)
- Outcome
- Decreased LV ejection fraction and depressed LV strain during hospitalization
- Follow-up
- During hospitalization
Main finding
As reported in the abstract
Decreased LV ejection fraction
35%
Depressed LV strain (either 4CH-LVLS or mid-LVCS)
45%
Observational data: associations, not effects.
Further findings
Association of LV strain parameters at admission with adverse outcomes (covariate-adjusted individual models)
| Adjusted odds ratio (95% CI) | ||
|---|---|---|
| 4CH-LVLS | 1.09 (1.07–1.12) | |
| mid-LVCS | 1.06 (1.04–1.09) | |
| Worst LV strain Z score between 4CH-LVLS and mid-LVCS | 1.30 (1.21–1.41) | |
| Early diastolic longitudinal strain rate | 1.68 (1.26–2.23) | |
| 0.512Adjusted odds ratio (log scale) |
- Association of LV strain parameters at admission with adverse outcomes (covariate-adjusted individual models): Covariate-adjusted individual models for each strain parameter
Time course of LV strain
- Worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness
- ≈5 days
- Abnormal LV strain normalized within 1 week
- 50%
- Abnormal LV strain normalized within 50 days
- 95%
In-hospital adverse outcomes
- Patients with in-hospital adverse outcomes
- 35%
- Older
- P = 0.003
- More likely abnormal troponin at admission
- P < 0.001
- Higher C-reactive protein at admission
- P < 0.001
- Higher indexed LV end-diastolic volume at admission
- P < 0.001
- Higher indexed LV mass at admission
- P = 0.015
- Worse LV ejection fraction at admission
- P < 0.001
- Worse 4CH-LVLS at admission
- P = 0.002
- Worse mid-LVCS at admission
- P = 0.001
Age
- Median age
- 8.7 years [interquartile range, 5.3-12.9]
Original publication
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