Prognostic Value of Speckle Tracking Echocardiography-Derived Strain in Unmasking Risk for Arrhythmias in Children with Myocarditis

<b>Background/Objectives:</b> Risk assessment in pediatric myocarditis is challenging, particularly when left ventricular ejection fraction (LVEF) is preserved. This study aimed to evaluate LV myocardial deformation using speckle-tracking echocardiography (STE)-derived longitudinal +strain (LS) and assessed its diagnostic and prognostic value in children with myocarditis. <b>Methods:</b> Retrospective STE-derived layer-specific LV LS analysis was performed on echocardiograms from patients within the multicenter, prospective registry for pediatric myocarditis "MYKKE". Age- and sex-adjusted logistic regression and ROC analysis identified predictors of cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, atrioventricular blockage III°) and major adverse cardiac events (MACE: need for mechanical circulatory support (MCS), cardiac transplantation, and/or cardiac death). <b>Results:</b> Echocardiograms from 175 patients (median age 15 years, IQR 7.9-16.5 years; 70% male) across 13 centers were included. Cardiac arrhythmias occurred in 36 patients (21%), and MACE in 28 patients (16%). Impaired LV LS strongly correlated with reduced LVEF (r > 0.8). Impaired layer-specific LV LS, reduced LVEF, LV dilatation, and increased BSA-indexed LV mass, were associated with the occurrence of MACE and cardiac arrhythmias. In patients with preserved LVEF, LV LS alone predicted cardiac arrhythmias (<i>p</i> < 0.001), with optimal cutoff values of -18.0% for endocardial LV LS (sensitivity 0.69, specificity 0.94) and -17.0% for midmyocardial LV LS (sensitivity 0.81, specificity 0.75). <b>Conclusions:</b> In pediatric myocarditis, STE-derived LV LS is not only a valuable tool for assessing systolic myocardial dysfunction and predicting MACE but also identifies patients at risk for cardiac arrhythmias, even in the context of preserved LVEF.

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Journal
Biomedicines
Published
2024-10-16
DOI
https://doi.org/10.3390/biomedicines12102369
Citations
2
Primary Topic
Viral Infections and Immunology Research
Type
article
Field-Weighted Citation Impact
0.80

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article

Prognostic Value of Speckle Tracking Echocardiography-Derived Strain in Unmasking Risk for Arrhythmias in Children with Myocarditis

Nele Rolfs, Fatima I. Lunze, Inga Voges, Katja Reineker et al.
2 citations
Biomedicines
Viral Infections and Immunology Research
0.80
article

Prognostic Value of Speckle Tracking Echocardiography-Derived Strain in Unmasking Risk for Arrhythmias in Children with Myocarditis

Nele Rolfs, Fatima I. Lunze, Inga Voges, Katja Reineker, E. Schwarzkopf, W. Frede, Karin Klingel, I. Altmann, Thomas Pickardt, Franziska Seidel, Cynthia Huber, G. Wiegand, Daniel Messroghli, Bernd Opgen‐Rhein, Stephan Schubert, D. Kiski, Felix Anderheiden, Martin Boehne, T. Hecht, Marcus Fischer, M. Khedim
article en
2 citations

Abstract

<b>Background/Objectives:</b> Risk assessment in pediatric myocarditis is challenging, particularly when left ventricular ejection fraction (LVEF) is preserved. This study aimed to evaluate LV myocardial deformation using speckle-tracking echocardiography (STE)-derived longitudinal +strain (LS) and assessed its diagnostic and prognostic value in children with myocarditis. <b>Methods:</b> Retrospective STE-derived layer-specific LV LS analysis was performed on echocardiograms from patients within the multicenter, prospective registry for pediatric myocarditis "MYKKE". Age- and sex-adjusted logistic regression and ROC analysis identified predictors of cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation, atrioventricular blockage III°) and major adverse cardiac events (MACE: need for mechanical circulatory support (MCS), cardiac transplantation, and/or cardiac death). <b>Results:</b> Echocardiograms from 175 patients (median age 15 years, IQR 7.9-16.5 years; 70% male) across 13 centers were included. Cardiac arrhythmias occurred in 36 patients (21%), and MACE in 28 patients (16%). Impaired LV LS strongly correlated with reduced LVEF (r > 0.8). Impaired layer-specific LV LS, reduced LVEF, LV dilatation, and increased BSA-indexed LV mass, were associated with the occurrence of MACE and cardiac arrhythmias. In patients with preserved LVEF, LV LS alone predicted cardiac arrhythmias (<i>p</i> < 0.001), with optimal cutoff values of -18.0% for endocardial LV LS (sensitivity 0.69, specificity 0.94) and -17.0% for midmyocardial LV LS (sensitivity 0.81, specificity 0.75). <b>Conclusions:</b> In pediatric myocarditis, STE-derived LV LS is not only a valuable tool for assessing systolic myocardial dysfunction and predicting MACE but also identifies patients at risk for cardiac arrhythmias, even in the context of preserved LVEF.

BiomedicinesVol. 12(10)
University of Freiburg (DE), Heidelberg University (DE), Heart and Diabetes Center North Rhine-Westphalia (DE), University Hospital Heidelberg (DE), Medizinische Hochschule Hannover (DE), Humboldt-Universität zu Berlin (DE), Universitätsklinikum Erlangen (DE), University Hospital Münster (DE), Deutsches Herzzentrum der Charité (DE), University Hospital Schleswig-Holstein (DE), Leipzig Heart Institute (DE), Universitätsmedizin Göttingen (DE), University Children's Hospital Tübingen (DE), German Centre for Cardiovascular Research (DE), Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE), Deutsches Herzzentrum München (DE), Freie Universität Berlin (DE), Charité - Universitätsmedizin Berlin (DE), Ludwig-Maximilians-Universität München (DE), RWTH Aachen University (DE), Ruhr University Bochum (DE), University of Lübeck (DE)
Bundesministerium für Bildung und Forschung, Berliner Sparkassenstiftung Medizin
Good health and well-being
Openalex Percentile: Top 23%
Viral Infections and Immunology Research
0.80
DOIOpen Access PDFOpenAlex
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