Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-CoV-2 infection

Abstract

Aims Compared with adult patients, clinical manifestations of children’s coronavirus disease-2019 (COVID-19) are generally perceived as less severe. The objective of this study was to evaluate cardiac involvement in previously healthy children with asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Methods and results We analysed a cohort of 53 paediatric patients (29 males, 55%), mean age 7.5 ± 4.7 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. Thirty-two age, sex, and body surface area comparable healthy subjects were used as control group. Left ventricular ejection fraction was within normal limits but significantly lower in the cases group compared to controls (62.4 ± 4.1% vs. 65.2 ± 5.5%; P = 0.012). Tricuspid annular plane systolic excursion (20.1 ± 3 mm vs. 19.8 ± 3.4 mm; P = 0.822) and left ventricular (LV) global longitudinal strain (−21.9 ± 2.4% vs. −22.6 ± 2.5%; P = 0.208) were comparable between the two groups. Regional LV strain analysis showed a significant reduction of the LV mid-wall segments strain among cases compared to controls. Furthermore, in the cases group, there were 14 subjects (26%) with a regional peak systolic strain below −16% (−2.5 Z score in our healthy cohort) in at least two segments. These subjects did not show any difference regarding symptoms or serological findings. Conclusion SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.

Segmental cardiac strain assessment by two‐dimensional speckle‐tracking echocardiography in surviving MIS‐c patients: Correlations with myocardial flow reserve (MFR) by 13 N‐ammonia PET‐CT

“…Interestingly, speckle‐tracking derived peak systolic longitudinal strain, evaluated at rest, correlated with segmental MFR, obtained after pharmacological stress with adenosine. These findings suggest that impaired vasodilation capacity may contribute to myocardial deformation abnormalities, which were also reported in the follow‐up of COVID‐19 pediatric patients by previous authors 9,20 …”

The usefulness of speckle tracking echocardiography in identifying subclinical myocardial dysfunction in young adults recovered from mild COVID‐19

“…In severe cases of COVID-19 infection, such as acute respiratory distress syndrome with possible pulmonary thrombosis, 30 According to a recent study, SARS-CoV-2 infection was related with myocardial deformation in LV mid-wall segments in about 25% of asymptomatic or mildly symptomatic children, lasting at least 3 months after the infection. 23 The different results in terms of LV-GLS distri- In our study, a sensitive diagnostic method such as strain echocardiography detected a subclinical myocardial dysfunction in many patients who recovered from mild and/or asymptomatic SARS-CoV2 infection. As compared to the few studies available, we included a highly selected population of young adults without any other known factors able to influence myocardial deformation, suggesting that a comprehensive echocardiographic evaluation during cardiology follow-up could be considered in this setting.…”

“…It is unclear whether these patients should have a dedicated follow‐up, especially with echocardiography evaluations. According to a recent study, SARS‐CoV‐2 infection was related with myocardial deformation in LV mid‐wall segments in about 25% of asymptomatic or mildly symptomatic children, lasting at least 3 months after the infection 23 . The different results in terms of LV‐GLS distribution abnormalities between pediatric patients and our population can be explained by the age difference and also by different echocardiographic vendors.…”

“…Based on previous studies, 23,24 we considered reduced LV-GLS values as the presence of a GLS lower than −16% in ≥2 segments, a value significantly below the normality range proposed in a large meta-analysis.…”

COVID-19 Pnömonili Hastaların Taburculuk Sonrası Sağ Ventrikül Fonksiyonunun Sağ Ventriküler Erken Giriş-Çıkış İndeksi ile Değerlendirilmesi

“…COVID-19 has been found to cause subclinical myocardial dysfunction even in mildly symptomatic patients [11,12]. Despite regular vaccination, the spread of the virus has not been stopped.…”