Neurocardiac injury associated with the severity of motor involvement in pediatric patients with Guillain Barre Syndrome

Abstract

BackgroundThe term neurogenic stunned myocardium has been used to summarize the myocardial abnormalities in the setting of nervous system injury. Over the past 10 years, numerous case reports have been documenting reversible neurologically stunned myocardium coinciding with clinical manifestations of Guillain Barre Syndrome (GBS). However, most case reports were performed in adult GBS patients, with no reports in the pediatric population. ObjectivesThe primary outcome of this paper was to prove or rule out myocardial dysfunction in GBS patients, while secondary outcomes were to correlate the observed dysfunction with the degree of motor disability using the motor function measure (MFM) score and with the degree of autonomic dysfunction in affected patients. MethodsForty patients with GBS were assessed for motor disability using the MFM. Left ventricular (LV) diastolic function was assessed using tissue Doppler imaging, while LV systolic function was assessed using 3D speckle tracking echocardiography (3D-STE). Forty healthy controls were recruited to benchmark the echocardiographic parameters. ResultsPatients' group showed elevated LV E/E' compared to control denoting LV diastolic dysfunction. The 3 D derived LV global longitudinal strain (GLS) and LV EF were significantly lower in cases indicating LV systolic dysfunction in the patients' group. MFM was significantly correlated to LV E/E′ (r = −0.51 p = 0.001), LV 3D EF (r = 0.38, p = 0.016) and 3D LVGLS (r 0.37, p = 0.02). Moreover, systolic and diastolic dysfunction was more evident in cases with autonomic dysfunction. ConclusionsPediatric patients with GBS could have subtle myocardial dysfunction that can be detected by non-conventional echocardiography. Myocardial involvement seems to be induced by autonomic dysfunction. Motor function was closely linked to myocardial involvement, and the severity of motor affection could be used as predictors for myocardial dysfunction in these patients.