Comparison of Strain and Conventional Echocardiography in Predicting ICU Needs in MIS-C

Saturday, January 21, 2023

5:15 PM – 5:30 PM PT

Location: 308

First Author(s)

Esther J. Kim, MD

Childrens National Health Systems
Washington, District of Columbia

Disclosure information not submitted.

Co-Author(s)

MS

Matthew Sharron, MD

Associate Professor
Children's National Hospital / George Washington University School of Medicine, United States

Disclosure information not submitted.
AA

Ashley Austin

Echocardiography Technologist
Children's National Hospital, United States

Disclosure information not submitted.
ND

Niti Dham, M.D.

M.D.
Children's National Hospital, United States

Disclosure information not submitted.
SB

Sonali Basu, MD

Critical Care Attending
Children's National Health Systems - Washington, DC
Washington, District of Columbia

Disclosure(s): General Electric Healthcare: Consulting fees or other remuneration (Ongoing)

Disclosure(s):

Sonali Basu, MD: General Electric Healthcare: Consulting fees or other remuneration (Ongoing)

INTRODUCTION: Multisystem Inflammatory Syndrome in Children (MIS-C) after SARS-CoV-2 infection is often complicated by ventricular dysfunction. Our prior work suggests that strain echocardiography (SE) detects abnormalities in cardiac function in ICU patients unrecognized by conventional echocardiography (CE). This study compares the relative strengths of CE and SE in predicting needs for ICU level therapies in MIS-C patients.

METHODS : A retrospective, single center analysis was performed on patients admitted to a quaternary-care children's hospital with the diagnosis of MIS-C from March 2020 to January 2022. Only patients with CE and SE measured prior to initiation of vasoactives were included. Abnormal LVEF was defined as < 55% and abnormal strain as <= -17.2%. Clinical metrics included use of positive pressure ventilation (PPV), vasoactives, or any ICU level care.

RESULTS: Of 90 patients diagnosed with MIS-C, median LVEF was normal in both normal (64.0%) and abnormal strain (57.2%) groups. We found 97.6% of patients with normal strain had normal LVEF but only 57.1% of those with normal LVEF had normal strain. Median LVEF was normal in both those who did and did not require ICU level care (63% vs 57.1%), and those who did and did not require vasoactives (62.4% vs 56.5%). Strain was abnormal in patients who required ICU level care, PPV, and vasoactives (-13.8%, -12.9%, -13.8% respectively), compared to those who did not (all -19.3%, p all < 0.001). Sensitivity analysis showed strain was superior to LVEF in identifying need for ICU level care (75.8% vs 39%), PPV (88% vs 48%), and vasoactives (90% vs 55%). Negative predictive value of strain was superior to LVEF for similar outcomes (ICU level care (80.9% vs 72%), PPV (92.7% vs 81.9%) and vasoactives (95.1% vs 87.2%)).

CONCLUSIONS: We demonstrate that SE detects abnormalities in cardiac function in MIS-C patients unrecognized by CE. In both ICU and non-ICU patients, we found compared to LVEF, detection of abnormal strain better identifies patients who will need ICU level therapies. Similarly, a measurement of normal strain is superior to a normal LVEF in predicting those who will not need these interventions.