2D Speckle Tracking Strain Echocardiography in Multisystem Inflammatory Syndrome in Children: A Multicenter Analysis From the MUSIC Study

Francesca Sperotto, Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, MA (F.S., A. Dionne, J.W.N., K.G.F.).
Valiantsina Kazlova, Carelon Research, Newton, MA (V.K., F.L.T.).
Felicia L. Trachtenberg, Carelon Research, Newton, MA (V.K., F.L.T.).
Dongngan T. Truong, Division of Cardiology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., C.M.F.).
Sanjeev Aggarwal, Children's Hospital of Michigan, Detroit (S.A.).
Joseph R. Block, Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (J.R.B.).
Tamara T. Bradford, Division of Cardiology, Department of Pediatrics, Louisiana State University, Children's Hospital of New Orleans, LA (T.B.).
Sujatha Buddhe, Department of Pediatric Cardiology, University of Stanford, Palo Alto, CA (S.B.).
Audrey Dionne, Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, MA (F.S., A. Dionne, J.W.N., K.G.F.).
Andreea Dragulescu, Division of Cardiology, Department of Pediatrics, The Sick Kids Children's Hospital, Toronto, Canada (A. Dragulescu).
Kanwal M. Farooqi, Division of Cardiology, Department of Pediatrics, Columbia University, New York, NY (K.F.).
Daniel E. Forsha, Children's Mercy Hospital, University of Missouri Kansas City (D.E.F.).
Therese M. Giglia, Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, PA (T.M.G.).
Ian F. Golding, Rady Children's Hospital, San Diego, CA (I.F.G.).
Keren Hasbani, Division of Cardiology, Department of Pediatrics, University of Texas-Austin, Dell Children's Medical Center (K.H.).
Pei-Ni Jone, Division of Cardiology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Lurie Children's Hospital, Chicago, IL (P.-N.J.).
Anita Krishnan, Division of Cardiology, Department of Pediatrics, George Washington University, Children's National Hospital (A.K.).
Sean M. Lang, The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.M.L.).
Carol A. McFarland, Division of Cardiology, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City (D.T.T., C.M.F.).
Elizabeth C. Mitchell, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY (E.M.).
Elias Moussi Saad, Baylor College of Medicine, Houston, TX (E.M.S.).
Todd T. Nowlen, Phoenix Children's Hospital, Phoenix, AZ (T.N.).
Ricardo H. Pignatelli, Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Austin (R.P.).
Scott Pletzer, Medical University of South Carolina, Charleston (S.P.).
Ryan Serrano, Riley Hospital for Children, Indianapolis, IN (R.S.).
Divya Shakti, Division of Cardiology, Department of Pediatrics, University of Mississippi, Children's of Mississippi, Jackson (D.S.).
Shubhika Srivastava, Division of Cardiology, Nemours Children's Hospital, Wilmington, DE (S.S.).
Thor Thorsson, Mott Children's Hospital, University of Michigan, Ann Arbor (T.T.).
Jodie K. Votava-Smith, Children's Hospital Los Angeles, CA (J.K.V.-S.).
Hunter C. Wilson, Emory University School of Medicine, Atlanta, GA (H.W.).
Jane W. Newburger, Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, MA (F.S., A. Dionne, J.W.N., K.G.F.).
Kevin G. Friedman, Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, MA (F.S., A. Dionne, J.W.N., K.G.F.).

Document Type

Journal Article

Publication Date

9-1-2025

Journal

Circulation. Cardiovascular imaging

Volume

18

Issue

9

DOI

10.1161/CIRCIMAGING.124.017620

Keywords

SARS-CoV-2; child; echocardiography; global longitudinal strain; heart diseases; outcome assessment, health care; ventricular dysfunction

Abstract

BACKGROUND: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes. METHODS: We performed an ambi-directional, 32-center cohort study on hospitalized patients with MIS-C (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab. Generalized estimating equation modeling was used to test associations between LV strain and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant). RESULTS: Of 349 patients (median age, 8.7 years [interquartile range, 5.3-12.9]), 35% had decreased LV ejection fraction during hospitalization, and 45% had depressed LV strain (either 4-chamber LV longitudinal strain [4CH-LVLS] or mid-ventricular LV circumferential strain [mid-LVCS]). The worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness; 50% of abnormal LV strain normalized within 1 week, and 95% within 50 days. In-hospital adverse outcomes occurred in 35% of patients; these patients were older (P=0.003) and, at admission, had more likely abnormal troponin (P<0.001) higher C-reactive protein (P<0.001), higher indexed LV end-diastolic volume (P<0.001) and mass (P=0.015), worse LV ejection fraction (P<0.001), and worse LV strain (4CH-LVLS, P=0.002; mid-LVCS, P=0.001). Covariate-adjusted individual models for each strain parameter showed that 4CH-LVLS (adjusted odds ratio, 1.09 [95% CI, 1.07-1.12]), mid-LVCS (adjusted odds ratio, 1.06 [95% CI, 1.04-1.09]), worst LV strain Z score between 4CH-LVLS and mid-LVCS (adjusted odds ratio, 1.30 [95% CI, 1.21-1.41]), and early diastolic longitudinal strain rate (adjusted odds ratio, 1.68 [95% CI, 1.26-2.23]) at admission were found to be associated with adverse outcomes. CONCLUSIONS: 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.

Department

Pediatrics

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