PM1026: Mitral Annular Plane Systolic Excursion Index (iMAPSE): An Easy and Simple Tool for Assessment of Left Ventricular Systolic Function in Pediatric Patients with COVID-19

Background: COVID-19 is a disease which involves many organs including the heart. In this study, we aimed to show the correlation of iMAPSE and the left ventricular (LV) systolic function in pediatric patients diagnosed with COVID-19. Adult studies demonstrated a correlation between transthoracic echocardiogram measurements (ECHO) of MAPSE and left ventricular ejection fraction (LVEF) in patients with COVID-19. However, to our knowledge, no studies have been done in the pediatric population.

Methods: This is a retrospective study design of 38 pediatric patients admitted to our hospital who were diagnosed with COVID-19 and underwent an ECHO on admission between March 2021 and December 2021. Lateral M-Mode MAPSE was obtained from the left ventricle wall in the apical 4-chamber-view. To account for the great variation in body surface area (BSA) of pediatric patients and the increased number of children with morbid obesity admitted with COVID-19, ideal BSA was used and MAPSE was indexed to ideal BSA (iMAPSE). LVEF was measured by 3 methods: M-Mode, Simpson’s and 3D. Demographic and clinical data were collected from the patients’ electronic medical records. We used Stata 15 for our analyses. Data were summarized as counts and percentages for categorical and binary variables, and medians and interquartile range (IQR, representing the 25th-75th percentiles [Q25%-75%]) for continuous variables. We then used a linear regression model to analyze the relationship between our variables of interest. P-value of < 0.05 was considered significant.

Results: The median age of the patients at admission was 14 years (IQR: 5-16). 14 (37%) were males. Troponin levels had a median value of 102 pg/mL (IQR: 12-732). Inotropes were used in 13 (34%) of patients. Mortality was 0%. Using simple linear regression analysis, iMAPSE was shown to have a positive association with LVEF by M-Mode [β = 6.11, 95% confidence interval (CI) 1.7 to 10.4; P = 0.007], however, iMAPSE and LVEF by Simpson’s method (β=1.72, CI: 6.4 - 62.8 P: 0.456) and LVEF by 3D (β=5.78, CI: -0.34-11 P: 0.063,) did not show a significant association.

Conclusion: iMAPSE is a simple echocardiographic measurement that can be used as an additional method to determine LV systolic function in pediatric patients with COVID-19, especially in patients with poor acoustic windows. Larger studies are needed to assess iMAPSE as a screening tool for LV systolic function.