Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent sars-cov-2 infection

ABSTRACT

Background: Evidence suggests that, compared with adult patients, clinical manifestations of children's COVID-19 may be less severe. However, multiple reports have raised concern about the so called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) which resembles other inflammatory conditions (i.e. Kawasaki disease, toxic shock). Patients affected by PIMS-TS showed cardiac involvement with myocardial injury, reduced left ventricle systolic function and coronary artery abnormalities, and in some cases, need for inotropes/vasopressors and extracorporeal life support (ECLS). Little is known regarding cardiac involvement in pediatric patients with SARS-CoV-2 infection and none or only mild symptoms of disease. Methods: We analyzed 52 pediatric patients (29males, 56%) with diagnosis of SARS-CoV-2 infection based on either PCR analysis of nasopharingeal swab (NPS), or serological finding of IgG on blood sample and asymptomatic (23%) or only mildly symptomatic (77%) for COVID-19. Patients underwent transthoracic echocardiogram (TTE) after a median time of 3.6 months from diagnosis and negative NPS for SARS-CoV-2. Offline analysis with GE EchoPAC software to measure global longitudinal strain (GLS) of the LV using 2D speckle tracking imaging. Therefore, we compared the results with an age-matched group of 32 controls (18males, 56%). Results: Cases and controls were similar regarding age and gender. LV biplane EF was significantly lower in the cases group, although still in the normal range (62.4±4.1% vs. 65.2±5.5%, p=0.012). TAPSE and LV-GLS were comparable between the two groups. GLS analysis showed significant strain reduction of the LV mid-wall segments and of the basal anterior, posterior and septal inferior segments among cases compared to controls. On the other hand, apical segments showed higher deformation in cases compared to controls. Furthermore, in the case group there were 14 subjects (27%) with a strain below 16% (mean value minus 2.5 SD) in at least 2 segments. Conclusion: SARS-CoV-2 infection may affect LV deformation in asymptomatic or only mildly symptomatic children, showing a peculiar pattern with lower longitudinal strain in all mid-wall segments of LV compared to control subjects. The clinical significance of this findings is unclear and follow-up is needed to verify the reversibility of this alterations.