Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent SARS-CoV-2 infection

Background: Evidence suggests that clinical manifestations of children's COVID-19 may be less severe However, it has been described the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) which resembles other inflammatory conditions (i e Kawasaki disease) Patients affected by PIMS-TS showed cardiac involvement with myocardial injury, reduced left ventricle systolic function and coronary artery abnormalities Little is known regarding cardiac involvement in pediatric patients with asymptomatic or mildly symptomatic SARS-CoV-2 infection Methods: We analyzed 23 pediatric patients (13males, 56%) with diagnosis of SARS-CoV-2 infection based on PCR analysis of nasopharin-geal swab (NPS), and asymptomatic or only mildly symptomatic for COVID-19 Patients underwent standard transthoracic echocardiogram (TTE) within 2-3 month from diagnosis and after negative NPS for SARS-CoV-2 We performed offline analysis with GE EchoPAC software to measure global longitudinal strain (GLS) of the LV using 2D speckle tracking imaging Therefore, we compared the results with a matched group of 23 controls (13males, 56%) Results: Cases and controls were similar regarding age (5 9 ± 4 1years vs 6 4 ± 4 4 years, p = 0 63), body surface area (0 98 ± 0 3m2 vs 0 8 ± 0 4m2, p = 0 17), LV FS (37 9 ± 5 9% vs 36 4 ± 8 3%, p = 0 74) and LV biplane EF (63 9 ± 5 2% vs 66 4 ± 5 3%, p = 0 11) GLS analysis showed significant strain reduction of the LV mid-wall segments and of the basal anterior, posterior and septal inferior segments among cases compared to controls Furthermore, in the case group there were 7 subjects (30%) with a strain below 16 5% in at least 3 segments Conclusion: SARS-CoV-2 infection may affect LV deformation in asymptomatic or only mildly symptomatic children, showing a peculiar pattern with lower longitudinal strain in all mid-wall segments of LV compared to control subjects The clinical significance of this findings is unclear and follow-up is needed to verify the reversibility of this alterations