Value of 2D Speckle Tracking Echocardiography in Assessment of Pediatric Patients with History of Carditis at Children's Hospital

Abstract

Abstract Background Primary myocarditis in pediatrics is presumed to be due to either an acute viral infection or a post-viral autoimmune response. Secondary myocarditis occurs due to chemotherapy, renal disease, systemic lupus erythematosus, or association with Kawasski disease. Two-dimensional (2D) speckle-tracking echocardiography allows an objective and quantitative evaluation of regional and longitudinal cardiac function. Aim To assess the echocardiographic changes in pediatric patients presented with carditis at their presentation and at follow-up after four weeks to detect any residual cardiac affection. Methods This study was a prospective controlled-cohort study that studied the two- dimensional speckle-tracking echocardiography changes in 30 pediatric patients with the diagnosis of carditis and 30 healthy age- and sex-matched controls. The study was conducted at the children's hospital, Ain Shams University, Egypt. It was done in the period from August 2021 until July 2023. A full medical history and clinical examination were done. Cardiac enzymes and two-dimensional (2D) speckle tracking echocardiography were done at admission and four weeks post-treatment. Results The median age of patients in the study was 9.5 years (IQR 3–11). They were 60% females and 40% males. The leading cause of carditis in our patients was viral infection, being seen in 46.7% of patients. The most common symptoms and signs at presentation were tachycardia and tachypnea. Creatinin Kinase MB was elevated in 30%, while serum troponin was high in 40%. Intravenous immunoglobulin (IVIG) was given for 60% of the patients, while steroids were given to 40%. Four patients (13.3%) needed inotropic support with PICU admission. Echocardiography showed that the left ventricle was dilated in 30% of patients. Three patients (10%) had impaired cardiac function and had abnormal global longitudinal strain (GLS) as determined by a two-dimensional speckle tracking echo (hypokinesia) with a GLS of -15%. At follow-up after four weeks, the clinical examination and investigations were unremarkable. Two-dimensional speckle echo was normal in all patients. GLS was within normal value in all patients (-19.13±1.45)% but lower than the control group (-20.36 ± 1.17)% (p-value 0.001). We found a positive relationship between global longitudinal strain at presentation with aspartate aminotransferase and cardiac enzymes (creatine kinase total and creatine kinase MB (p-values 0.000, 0.012, and 0.001), respectively. Conclusion Monitoring cardiac function with two-dimensional speckle tracking echo is an important tool in detecting critically ill patients with carditis, and follow-up is recommended to detect further subtle cardiac affection.