Abstract 10848: Increasing Left Anterior Descending Artery Size is Associated with Worsening Myocardial Function in the Setting of Multisystem Inflammatory Syndrome in Children

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular complications include left ventricular dysfunction and coronary artery abnormalities (CAA). Little is known, however, about the interaction between LV function and CAA. We aimed to assess the hypothesis that increased coronary artery size is inversely correlated with LV function utilizing left ventricular ejection fraction (LVEF) and indices of myocardial work. Methods: Two-dimensional and speckle-tracking echocardiograms were performed in 34 MIS-C patients at admission. Biplane LVEF and coronary artery Z scores were measured, and pressure-strain loops were used to calculate indices of myocardial work: global work index (GWI), global work efficiency (GWE), global wasted work (GWW), global constructive work (GCW), and global longitudinal strain (GS). Treating coronary artery Z-scores as a continuous variable, correlation analysis was performed. Results: LVEF and left anterior descending artery (LAD) Z-scores were inversely correlated (Spearman coefficient of -0.47; P =0.005). Both GWI and GCW demonstrated an inverse relationship with increasing LAD Z-scores, but both were not statistically significant (Spearman coefficient -0.21; P =0.239 and Spearman coefficient -0.21; P= 0.235). GS also exhibited a trend of worsening (less negative scores) with increasing LAD Z-scores but was not statistically significant (Spearman coefficient 0.29; P =0.095). GWE and GWW did not correlate with any coronary artery Z-scores and left main coronary or right coronary artery Z-scores did not correlate with any markers of function. Conclusion: Increasing LAD Z-score showed a statistically significant association with decreased LVEF. Additionally, while not statistically significant, GWI, GCW, and GS all demonstrated a trend of decreased indices of myocardial work as LAD Z-score increases. In conclusion, this data suggests that patients with higher coronary artery Z-scores at admission are at increased risk of myocardial dysfunction.