Abstract 15765: Left Ventricular Strain on Echocardiogram is Associated With Abnormal Cardiac MRI Findings in Pediatric Patients With Covid-19

Abstract

Introduction: Cardiac injury in COVID-19 may manifest as myocarditis, cardiomyopathy, ventricular arrhythmia, heart failure or cardiogenic shock. Although cardiac manifestations of COVID-19 is known, there is little literature regarding myocardial involvement in pediatric patients with COVID-19. Adult studies have suggested up to 80% of patients who have recovered from COVID-19 have abnormal cardiac MRI (CMR) findings. They have also suggested that up to 80% of adult patients hospitalized with COVID-19 have abnormal left ventricular global longitudinal strain (LV-GLS) and have used this to determine the extent of myocardial involvement. These findings can indicate potential long term cardiac sequalae. Our aim was to assess if abnormal LV-GLS from echocardiogram correlates with abnormal CMR findings in pediatric patients with history of COVID-19. Methods: This study is an IRB-approved retrospective chart review of pediatric patients less than 18 years old with a history of COVID-19 with evaluation of CMR and transthoracic echocardiograms (TTE) from 2020-2022. LV ejection fraction (LVEF) and LV-GLS were analyzed from TTE. CMR data includes LVEF, late gadolinium enhancement (LGE), parametric mapping (T1, T2 and extracellular volume). Comparisons between patient groups were made using Student's t-test, and p<0.05 was considered statistically significant. Results: Of the 47 patients with history of COVID-19, 24 patients were analyzed (mean age 14 + 4 years). All patients had preserved LVEF by TTE and CMR. 13 patients had abnormal CMR findings including LGE, and/or abnormal parametric mapping. In these 13 patients, mean LV-GLS was -16.6 + 2.1 (95%CI: -17.6, -15.5). Of the 11 patients with normal CMR findings, the mean LV-GLS was -19.3 + 2.9 (95%CI: -20.9, -17.8). There was significant difference in LV-GLS when comparing patients with CMR abnormalities versus those with normal CMR (t=-3.2, df=32, p=0.003). Conclusions: Abnormal LV-GLS on TTE despite normal LVEF may be associated with abnormal CMR findings in patients with a history of COVID-19. These findings suggest that cardiac involvement may persist in pediatric patients who had recovered from COVID-19. This may have implications on which patients will need CMR imaging and long-term follow-up.