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Left Atrial Strain in Multisystem Inflammatory Syndrome in Children and Associations with Systemic Inflammation and Cardiac Injury

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Abstract

Multisystem inflammatory syndrome in children (MIS-C) commonly involves cardiac injury with both systolic and diastolic dysfunction. Left atrial strain (LAS) detects subclinical diastolic dysfunction in adults but is infrequently used in children. We evaluated LAS in MIS-C and the associations with systemic inflammation and cardiac injury. In this retrospective cohort study, LAS parameters [reservoir (LAS-r), conduit (LAS-cd), and contractile (LAS-ct)] obtained from admission echocardiograms of MIS-C patients were compared to healthy controls and between MIS-C patients with and without cardiac injury (BNP > 500 pg/ml or troponin-I > 0.04 ng/ml). Correlation and logistic regression analyses were performed to assess LAS associations with admission inflammatory and cardiac biomarkers. Reliability testing was performed. We identified 118 patients with MIS-C and 20 healthy controls. Median LAS parameters were reduced in MIS-C patients compared to controls (LAS-r: 31.8 vs. 43.1%, p < 0.001; LAS-cd: − 28.8 vs. − 34.5%, p = 0.006; LAS-ct: − 5.2 vs. − 9.3%, p < 0.001) and reduced in MIS-C patients with cardiac injury (n = 59) compared to no injury (n = 59) (LAS-r: 29.6 vs. 35.8%, p = 0.001; LAS-cd: − 26.5 vs. − 30.4%, p = 0.036; LAS-ct: − 4.6 vs. − 9.3%, p = 0.008). A discrete LAS-ct peak was absent in 65 (55%) MIS-C patients but present in all controls (p < 0.001). Procalcitonin correlated strongly with averaged E/e’ (r = 0.55, p = 0.001). Moderate correlations were found for ESR and LAS-ct (r = − 0.41, p = 0.007) as well as BNP and LAS-r (r = − 0.39, p < 0.001) and LAS-ct (r = 0.31, p = 0.023). Troponin-I had only weak correlations. Intra-rater reliability was good for all LAS parameters, and inter-rater reliability was good to excellent for LAS-r, and fair for LAS-cd and LAS-ct. LAS analysis, particularly the absence of a LAS-ct peak, was reproducible and may be superior to conventional echocardiographic parameters for detecting diastolic dysfunction in MIS-C. No strain parameters on admission were independently associated with cardiac injury.

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Abbreviations

LAS:

Left atrial strain

LAS-r:

Left atrial reservoir strain

LAS-cd:

Left atrial conduit strain

LAS-ct:

Left atrial contractile strain

LVLS:

Left ventricular longitudinal strain

RVLS:

Right ventricular longitudinal strain

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Acknowledgements

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).

Funding

Dongngan T. Truong is a Co-Principal Investigator on a research study that receives funding from NHLBI Pediatric Heart Network and Pfizer.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Bryan M. Jepson, Matthew Beaver, John L. Colquitt, Dongngan T. Truong, Carol McFarland, Richard Williams, L. LuAnn Minich & Edem Binka

  2. Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Hillary Crandall

  3. Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Zhining Ou

  4. Intermountain Primary Children’s Hospital, Salt Lake City, UT, USA

    Devri Jensen

  5. Primary Children’s Hospital Outpatient Services, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Bryan M. Jepson

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All authors contributed to study conception and design. BMJ, MB, EB, and DJ contributed to data collection. ZO performed the statistical analysis. BMJ wrote the first manuscript draft. All authors reviewed prior drafts and approve of the final manuscript.

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Correspondence to Bryan M. Jepson.

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Jepson, B.M., Beaver, M., Colquitt, J.L. et al. Left Atrial Strain in Multisystem Inflammatory Syndrome in Children and Associations with Systemic Inflammation and Cardiac Injury. Pediatr Cardiol 45, 729–739 (2024). https://doi.org/10.1007/s00246-024-03417-9

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