Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19

• Published in: European heart journal cardiovascular imaging Vol. 24; no. 9; pp. 1241 - 1251
• Main Authors: Zuckerberg, Jeremy C, Matsubara, Daisuke, Kauffman, Hunter L, Chang, Joyce C, Calderon-Anyosa, Renzo, Patel, Chandni, Hogarty, Alexa N, Falkensammer, Christine B, Mercer-Rosa, Laura M, Quartermain, Michael D, Wang, Yan, Banerjee, Anirban
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 23-08-2023
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jead087

Abstract
Aims
We hypothesized left atrial (LA) stiffness may serve as a surrogate marker in children to differentiate elevated pulmonary capillary wedge pressure (PCWP) from normal and help detect diastolic dysfunction in myocardial injury due to multisystem inflammatory syndrome in children (MIS-C).
Methods and results
We validated LA stiffness in 76 patients (median age 10.5 years), 33 had normal PCWP (<12 mmHg) and 43 had elevated PCWP (≥12 mmHg). LA stiffness was applied to 42 MIS-C patients [28 with myocardial injury (+) and 14 without myocardial injury (−)], defined by serum biomarkers. The validation group consisted of a group with and without cardiomyopathies, whose PCWP values ranged from normal to severely elevated. Peak LA strain was measured by speckle-tracking and E/e′ from apical four chamber views. Noninvasive LA stiffness was calculated as: LAStiffness=E/e′LAPeakStrain (%−1). Patients with elevated PCWP showed significantly elevated LA stiffness [median 0.71%−1 vs. 0.17%−1, P < 0.001]. Elevated PCWP group showed significantly decreased LA strain (median: 15.0% vs. 38.2%, P < 0.001). Receiver operator characteristic (ROC) curve for LA stiffness yielded an area under the curve (AUC) of 0.88 and cutoff value of 0.27%−1. In MIS-C group, ROC curve yielded an AUC of 0.79 and cutoff value of 0.29%−1 for identifying myocardial injury.
Conclusion
In children with elevated PCWP, LA stiffness was significantly increased. When applied to children with MIS-C, LA stiffness classified myocardial injury accurately. LA stiffness and strain may serve as noninvasive markers of diastolic function in the pediatric population.
Graphical Abstract
Graphical Abstract