Three dimensional echocardiography and global longitudinal strain in the assessment of left ventricular function in children after PIMS-TS

ABSTRACT

Background and Aim: Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) is a new dis-ease affecting children, almost alwaysinvolving cardiovascular system and with potential long-term effects still unknown. Method(s) Prospective study enclosed 80 children aged 1-17 years (mean 8.2 years) diagnosed with PIMS-TS between June 2020 and June 2021 who were controlled 6 weeks and 6 months after the disease. In patients with severe cardiac involvement during acute phase (deteriorated left ventricular ejection fraction (LVEF) lt;55% and significantly elevated concentration of NT-pro-BNP (gt;5000 pg/ml) or troponine (gt;500 ng/ml)) the addi-tional check-up after 3 months was scheduled. In all patients at control points three dimensional echocardiography (3D-ECHO) and average global longitudinal strain (GLS) were used to assess left ventricular function. Result(s) In all patients the means of LVEF and average GLS were within normal limits at the time of all check-up points. For the whole group LVEF after 6 weeks was 60.5% (SD 3.1;51-69%) and GLS 21.2% (SD 3.9;12.4-29.4%). After 6 months LVEF increased to 63% (SD 2.4;58-69%) and GLS to 23.6% (SD 3.2;17.3-33.3%)-both significantly (plt;0.001). In the subgroup of 54 patients with originally mild cardiac involvement LVEF after 6 weeks was 60.7% (SD 2.6;57-69%) and GLS 21.8% (SD 3.4;17.3-29.4%). In the subgroup of 26 patients with severe cardiac involvement LVEF after 6 weeks was 59.6% (SD 3.1;55-67%) and was not significantly different than in subgroup with mild car-diac involvement (p = 0.175) while GLS was significantly lower (19.3%, SD 3.8;12.4-24.8%;p = 0.009). After 3 months in this group LVEF and GLS did not increase (respectively, 59.9%, 56-67%;p = 0.794 and 20.2%, 13.7-26.9%;p = 0.149). After 6 months LVEF in this subgroup increased to 62.8% (60-68%) and GLS to 22.6% (17.7-27%)-like in patients with mild cardiac involvement (plt;0.001). Conclusion(s) 3D-ECHO and GLS are highly applicable tools for the assessment of cardiac function in children after PIMS-TS. Patients with originally severe cardiovascular involvement have lower average GLS after 6 weeks. 6 months after PIMS-TS patients present significant improvement of left ventricular function. Average GLS seems to be more sensitive test for functional assess-ment than LVEF.