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Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children

Published online by Cambridge University Press:  03 August 2022

Enrico Piccinelli*
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Carles Bautista-Rodriguez
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Jethro Herberg
Affiliation:
Paediatrics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
Heechan Kang
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Sylvia Krupickova
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Ivan B Altamar
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Sara Moscatelli
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Jolanda Sabatino
Affiliation:
Università degli Studi “Magna Graecia” di Catanzaro, Catanzaro, Italy
Manjit Josen
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
Josefa Paredes
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
Elisabeth Whittaker
Affiliation:
Paediatrics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
Yogen Singh
Affiliation:
Neonatal Intensive Care Unit, Cambridge University Hospitals, Cambridge, UK University of Cambridge School of Clinical Medicine, Cambridge, UK
Alain Fraisse
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK
Giovanni Di Salvo
Affiliation:
Paediatric Cardiology Services, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College, London, UK Università degli Studi di Padova, Padova, Italy
*
Author for correspondence: Enrico Piccinelli, Royal Brompton Hospital, Sydney Street, London SW36NP, UK. Tel: +39 3803695320. E-mail: dottor.piccinelli@gmail.com

Abstract

Background:

Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking.

Methods:

We reviewed echocardiography findings of all multi-system inflammatory syndrome cases between 1st April and 31st July, 2020 and typical Kawasaki disease patients with coronary arteries abnormalities consecutively followed between 1st October, 2016 and June 30th, 2019.

Results:

We included 40 multi-system inflammatory syndrome children (25 males, 62.5%) and 45 Kawasaki disease patients (31 males, 68.9%) at a mean age of 6.4 years old and 8 years old, respectively. Four out of 40 multi-system inflammatory syndrome children had coronary arteries abnormalities. Left ventricle ejection fraction was normal in both groups. Global longitudinal strain was normal although Kawasaki disease group had significantly lower values (–20.0 versus –21.7%; p = 0.02). Basal segments were the most affected in Kawasaki disease patients with significant differences in the basal anterior, anterolateral, and anteroseptal strain: –18.2 versus –23.0% (p = 0.002), –16.7 versus –22.0% (p < 0.001), –16.7 versus –19.5% (p = 0.034), respectively. The basal anterolateral and anteroseptal segments in Kawasaki disease patients were the only ones with an absolute reduction of longitudinal strain (–16.7% both) consistent with the greater left main coronary involvement in this cohort.

Conclusions:

Our findings are consistent with the transient cardiac involvement in multi-system inflammatory syndrome, as opposed to the subtle and chronic myocardial involvement in Kawasaki disease children with coronary arteries abnormalities. We speculate that the mechanism of cardiac impairment in the few multi-system inflammatory syndrome children with reduced global longitudinal strain is not related to coronary arteries abnormalities.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

Denotes equal contribution.

References

Riphagen, S, Gomez, X, Gonzalez-Martinez, C, Wilkinson, N, Theocharis, P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 16071608. doi: 10.1016/S0140-6736(20)31094-1.CrossRefGoogle ScholarPubMed
Jones, VG, Mills, M, Suarez, D, et al. COVID-19 and Kawasaki disease: novel virus and novel case. Hosp Pediatr 2020; 10: 537540. doi: 10.1542/hpeds.2020-0123.CrossRefGoogle ScholarPubMed
Verdoni, L, Mazza, A, Gervasoni, A, et al. Articles an outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic : an observational cohort study. Lancet 2020; 6736: 18. doi: 10.1016/S0140-6736(20)31103-X.Google Scholar
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429436. doi: 10.1161/CIRCULATIONAHA.120.048360.CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324: 259269. doi: 10.1001/jama.2020.10369.CrossRefGoogle ScholarPubMed
Dufort, EM, Koumans, EH, Chow, EJ, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020; 383: 347358. doi: 10.1056/NEJMoa2021756.CrossRefGoogle ScholarPubMed
Feldstein, LR, Rose, EB, Horwitz, SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383: 334346. doi: 10.1056/NEJMoa2021680.CrossRefGoogle ScholarPubMed
Abrams, JY, Godfred-Cato, SE, Oster, ME, et al. Multisystem inflammatory syndrome in children associated with Severe Acute Respiratory Syndrome Coronavirus 2: a systematic review. J Pediatr 2020; 226:4554.e1. doi: 10.1016/j.jpeds.2020.08.003.CrossRefGoogle ScholarPubMed
Godfred-Cato, S, Bryant, B, Leung, J, et al. COVID-19-Associated multisystem inflammatory syndrome in children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 10741080. doi: 10.15585/mmwr.mm6932e2.CrossRefGoogle ScholarPubMed
Davies, P, Evans, C, Kanthimathinathan, HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4: 669677. doi: 10.1016/S2352-4642(20)30215-7.CrossRefGoogle Scholar
Levin, M. Childhood multisystem inflammatory syndrome – a new challenge in the pandemic. N Engl J Med 2020; 383: 393395. doi: 10.1056/NEJMe2023158.CrossRefGoogle ScholarPubMed
Clark, CB, Sanchez-de-Toledo, J, Bautista-Rodriguez, C, et al. Cardiac abnormalities seen in pediatric patients during the SARS-CoV2 pandemic: an international experience. J Am Heart Assoc 2020; 9: e018007. doi: 10.1161/JAHA.120.018007.CrossRefGoogle ScholarPubMed
Bautista-Rodriguez, C, Sanchez-de-Toledo, J, Clark, BC, et al. Multisystem inflammatory syndrome in children: an international survey. Pediatrics 2021; 147: e2020024554. doi: 10.1542/peds.2020-024554.CrossRefGoogle ScholarPubMed
Matsubara, D, Kauffman, HL, Wang, Y, et al. Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol 2020; 76: 19471961. doi: 10.1016/j.jacc.2020.08.056.CrossRefGoogle ScholarPubMed
Valverde, I, Singh, Y, Sanchez-de-Toledo, J, et al. Manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021; 143: 2132. Acute Cardiovascular. doi: 10.1161/CIRCULATIONAHA.120.050065.CrossRefGoogle ScholarPubMed
McCrindle, BW, Rowley, AH, Newburger, JW, et al. American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circ J 2017; 135: e927e999. doi: 10.1161/CIR.0000000000000484.Google Scholar
Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465495. doi: 10.1016/j.echo.2010.03.019.CrossRefGoogle ScholarPubMed
Sluysmans, T, Colan, SD. Structural measurements and adjustment for growth. In: Lai, WW, Cohen, MS, Geva, T, Mertens, L (eds). Echocardiography in Pediatric and Congenital Heart Disease. Wiley-Blackwell, West Sussex, UK, 2009. Chapter 5.Google Scholar
Colan, SD. Normal echocardiographic values for cardiovascular structures. Lai, WW, Cohen, MS, Geva, T, Mertens, L (eds). Echocardiography in Pediatric and Congenital Heart Disease. Wiley-Blackwell, West Sussex, UK, 2009. Appendix 1, 765785.Google Scholar
Manlhiot, C, Millar, K, Golding, F, et al. Improved classification of coronary artery abnormalities based only on coronary artery z-scores after Kawasaki disease. Pediatr Cardiol 2010; 31: 242249. doi: 10.1007/s00246–009–9599–7.CrossRefGoogle ScholarPubMed
Cantinotti, M, Scalese, M, Giordano, R, et al. Normative data for left and right ventricular systolic strain in healthy caucasian italian children by two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 2018; 31: 712720.e6. doi: 10.1016/j.echo.2018.01.006.CrossRefGoogle ScholarPubMed
Sabatino, J, Di Salvo, G, Krupickova, S, et al. Left Ventricular Twist Mechanics to Identify Left Ventricular Noncompaction in Childhood. Circ Cardiovasc Imaging 2019; 12: e007805. doi: 10.1161/CIRCIMAGING.118.007805.CrossRefGoogle ScholarPubMed
Yonesaka, S, Takahashi, T, Eto, S, et al. Biopsy-proven myocardial sequels in Kawasaki disease with giant coronary aneurysms. Cardiol Young 2010; 20: 602609. doi: 10.1017/S1047951109991132.CrossRefGoogle ScholarPubMed
Lin, Z, Zheng, J, Chen, W, Ding, T, Yu, W and Xia, B. Assessing left ventricular systolic function in children with a history of Kawasaki disease. BMC Cardiovasc Disord 2020; 20: 131. doi: 10.1186/s12872–020–01409–0.CrossRefGoogle ScholarPubMed
Muthusami, P, Luining, W, McCrindle, B, et al. Myocardial Perfusion, Fibrosis, and Contractility in children with Kawasaki Disease. JACC Cardiovasc Imaging 2018; 11: 19221924. doi: 10.1016/j.jcmg.2018.06.009.CrossRefGoogle ScholarPubMed
Bermejo, IA, Bautista-Rodriguez, C, Fraisse, A, et al. Short-term sequelae of multi-system inflammatory syndrome in children assessed by CMR. JACC Cardiovasc Imaging 2021; 14: 16661667. doi: 10.1016/j.jcmg.2021.01.035.CrossRefGoogle ScholarPubMed
Krupickova, S, Bautista-Rodriguez, C, Hatipoglu, S, et al. Myocardial deformation assessed by CMR in children after multi-system inflammatory syndrome (MIS-C). Int J Cardiol 2022; 346: 105106. doi: 10.1016/j.ijcard.2021.11.036.CrossRefGoogle Scholar