Relation Between High Sensitive C-Reactive Protein and Left Ventricular Speckle Strain in Critically Ill Children

Background: left ventricular dysfunction is one of the major determinates of the clinical outcomes in critically ill children. Early detection of myocardial dysfunction may be of help in modifying treatment in those   critically ill children. The aim of this study was to   investigate the relationship between High sensitive CRP(Hs CRP) and echocardiographic values in patients with critical illness and  also the role of  speckle tracking of the left ventricle  as a predictor of subclinical myocardial dysfunction and/or as a prognostic factor of survival in the studied patients. Methods :  Hs –CRP was measured  and echocardiographic images using tissue Doppler and speckle tracking two dimensional echo (STE)   were prospectively acquired in 30 critically ill children and also 30 healthy children as a control. Results: There is significant decrease in the EF by M mode ( 29.4+4.98 ) compared to the control ( 38.1+2.84 ). Systolic velocity of the mitral valve(S) by tissue Doppler was significantly decreased (4.4 versus 6.8 for the control),  A‰/A ratio significantly decreased (1.10 for the patient versus 1.52 for the control ). STE showed significant decreased  Left ventricular longitudinal strain(LVGLSS)  11.9 versus 24 .5 for the control. Hs CRP was significantly correlated with the left ventricle ejection fraction(LVEF), (S)  velocity by and longitudinal systolic strain by speckle tracking  .ROC curve  showed that Hs-CRP  [The AUR is 0.760, Sensitivity 85.36, specificity 84.6, Accuracy 84.7, PPV 84.6, NPV 89.6] was significant with cutoff  value 42.63. . A‰/A ratio and  TTP ( time to peak ) were the only echo parameters that showed significant relation with the fate  of patients. Conclusion : Abnormal left ventricular function by tissue Doppler and STE were detected in critically ill children and were significantly correlated with Hs CRP.