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Prognostic value of speckle tracking echocardiography-derived strain in unmasking risk for arrhythmias in children with myocarditis

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 assesse...

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Main Authors: Rolfs, Nele (Author) , Huber, Cynthia (Author) , Opgen-Rhein, Bernd (Author) , Altmann, Isabell (Author) , Anderheiden, Felix (Author) , Hecht, Tobias (Author) , Fischer, Marcus (Author) , Wiegand, Gesa (Author) , Reineker, Katja (Author) , Voges, Inga (Author) , Kiski, Daniela (Author) , Frede, Wiebke (Author) , Boehne, Martin (Author) , Khedim, Malika (Author) , Messroghli, Daniel (Author) , Klingel, Karin (Author) , Schwarzkopf, Eicke (Author) , Pickardt, Thomas (Author) , Schubert, Stephan (Author) , Lunze, Fatima I. (Author) , Seidel, Franziska (Author)
Format: Article (Journal)
Language:English
Published: 16 October 2024
In: Biomedicines
Year: 2024, Volume: 12, Issue: 10, Pages: 1-16
ISSN:2227-9059
DOI:10.3390/biomedicines12102369
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.3390/biomedicines12102369
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Author Notes:Nele Rolfs, Cynthia Huber, Bernd Opgen-Rhein, Isabell Altmann, Felix Anderheiden, Tobias Hecht, Marcus Fischer, Gesa Wiegand, Katja Reineker, Inga Voges, Daniela Kiski, Wiebke Frede, Martin Boehne, Malika Khedim, Daniel Messroghli, Karin Klingel, Eicke Schwarzkopf, Thomas Pickardt, Stephan Schubert, Fatima I. Lunze and Franziska Seidel on behalf of the MYKKE Consortium
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Summary: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.
Item Description:Gesehen am 15.08.2025
Physical Description:Online Resource
ISSN:2227-9059
DOI:10.3390/biomedicines12102369

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