2D Speckle Tracking Strain Echocardiography in Multisystem Inflammatory Syndrome in Children: A Multicenter Analysis From the MUSIC Study.
Document Type
Article
Publication Date
9-2025
Identifier
DOI: 10.1161/CIRCIMAGING.124.017620
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.
Journal Title
Circ Cardiovasc Imaging
Volume
18
Issue
9
First Page
017620
Last Page
017620
MeSH Keywords
Humans; Male; Female; Child; Systemic Inflammatory Response Syndrome; Child, Preschool; Echocardiography; Ventricular Dysfunction, Left; Ventricular Function, Left; COVID-19; Stroke Volume
PubMed ID
40899279
Keywords
SARS-CoV-2; child; echocardiography; global longitudinal strain; heart diseases; outcome assessment, health care; ventricular dysfunction
Recommended Citation
Sperotto F, Kazlova V, Trachtenberg FL, et al. 2D Speckle Tracking Strain Echocardiography in Multisystem Inflammatory Syndrome in Children: A Multicenter Analysis From the MUSIC Study. Circ Cardiovasc Imaging. 2025;18(9):e017620. doi:10.1161/CIRCIMAGING.124.017620
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