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

Biomedicines, vol. 12, pp. 2369

Abstract

Background/Objectives: 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. Methods: 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). Results: 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 (p < 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). Conclusions: 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.

Authors 20

1. Nele Rolfs corresponding

   Humboldt-Universität zu Berlin · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

   Affiliation as printed

   Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

   DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany

   Department of Congenital Heart Disease—Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany

2. Cynthia Huber

   Universitätsmedizin Göttingen · University of Göttingen

   Affiliation as printed

   Department of Medical Statistics, University Medical Center Göttingen, 37075 Göttingen, Germany

3. Bernd Opgen‐Rhein

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

   Affiliation as printed

   Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

   Department of Congenital Heart Disease—Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany

4. Isabell Altmann

   Leipzig University

   Affiliation as printed

   Clinic for Pediatric Cardiology, Heart Centre, University of Leipzig, 04109 Leipzig, Germany

5. Felix Anderheiden

   Universitätsklinikum Erlangen

   Affiliation as printed

   Pediatric Cardiology, University Hospital Erlangen, 91054 Erlangen, Germany

6. T. Hecht

   Heart and Diabetes Center North Rhine-Westphalia · University Hospitals of the Ruhr-University of Bochum

   Affiliation as printed

   Center for Congenital Heart Disease, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Medical Faculty OWL (University of Bielefeld), 32345 Bad Oeynhausen, Germany

7. G. Wiegand

   Universitätsklinikum Tübingen · University Children's Hospital Tübingen

   Affiliation as printed

   Pediatric Cardiology, University Hospital Tübingen, 72076 Tuebingen, Germany

8. Katja Reineker

   University of Freiburg · Universitäts-Herzzentrum Freiburg-Bad Krozingen

   Affiliation as printed

   Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany

9. Inga Voges

   German Centre for Cardiovascular Research · University Hospital Schleswig-Holstein

   Affiliation as printed

   DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, 24105 Kiel, Germany

   Department for Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany

10. D. Kiski

    University of Münster · University Hospital Münster

    Affiliation as printed

    Pediatric Cardiology, University Hospital Münster, 48149 Muenster, Germany

11. W. Frede

    Heidelberg University · University Hospital Heidelberg

    Affiliation as printed

    Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, 69120 Heidelberg, Germany

12. Martin Boehne

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany

13. M. Khedim Aachen Pediatric Cardiology

    RWTH Aachen University · Universitätsklinikum Aachen

    Affiliation as printed

    Pediatric Cardiology, University Hospital RWTH Aachen, 52074 Aachen, Germany

14. Daniel Messroghli

    Humboldt-Universität zu Berlin · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany

    Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, 10117 Berlin, Germany

15. Karin Klingel

    University of Tübingen · Universitätsklinikum Tübingen

    Affiliation as printed

    Cardiopathology, Institute for Pathology, University Hospital Tuebingen, 72076 Tuebingen, Germany

16. Eicke Schwarzkopf

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

    Department of Congenital Heart Disease—Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany

17. Thomas Pickardt

    Competence Network for Congenital Heart Defects

    Affiliation as printed

    Competence Network for Congenital Heart Defects, 13353 Berlin, Germany

18. Stephan Schubert

    German Centre for Cardiovascular Research · Heart and Diabetes Center North Rhine-Westphalia · University Hospitals of the Ruhr-University of Bochum

    Affiliation as printed

    Center for Congenital Heart Disease, Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Medical Faculty OWL (University of Bielefeld), 32345 Bad Oeynhausen, Germany

    DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany

19. Fatima I. Lunze

    Humboldt-Universität zu Berlin · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany

    Department of Congenital Heart Disease—Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany

20. Franziska Seidel

    Humboldt-Universität zu Berlin · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin · Freie Universität Berlin · Deutsches Herzzentrum der Charité

    Affiliation as printed

    Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany

    DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany

    Department of Congenital Heart Disease—Pediatric Cardiology; Deutsches Herzzentrum der Charité, 13353 Berlin, Germany