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

Wegdan Mawlana, Khaled Talaat, Osama Tolba
5.699 1.249


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),  É/à 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. .  É/à 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.











High sensitive CRP , Speckle tracking echo, Children

Full Text:




1- Cholley BP , Veillard-Baron A, Mebazaa A. Echocardiography in the ICU: time for widespread use . Inten Care Med 2006; 32:9- 10.

2- Hassan B, Morsy S, Siam A, et al. Myocardial injury in critically ill children: a case control study. ISRN Cardiology 2014; 4:1.

3- Sturgess D J, Marwick T H, Joyce C J et al. Tissue Doppler in critical illness; a prospective cohort study. Crit Care 2007, 11: R 97.

4- Al-Naami GH. Torsion of young hearts: a speckle tracking study of normal infants, children and adolescents.Eur J Echocardiogr. 2010; 11: 853-62.

5- Koenig, W. and Pepy S. C reactive protein risk prediction: sensitivity . Ann. Intern. Med 2002; 136: 550-2. specificity, high

6- Ferreira FL, Bota DP, Bross A ,et al . Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients. JAMA 2001; 286: 11754-9.

7- Hamwi A, Vukovich T, Wagner O, et al. Evaluation of turbidimetric high-sensitivity C-Reactive protein assays for cardiovascular risk sstimation. Clin Chemistry 2001; 47: 2044-2046.

8- Tibby SM, Brock G, Marsh M J, et al. Hemodynamic monitoring in critically ill children. Care Cri Ill 1997;13:86-9.

9- Vignon P, Allot V, Lesage J, et al. Diagnosis of left ventricular diastolic dysfunction in the setting of acute changes in loading conditions . Crit Care 2007; 11:R43.

10- Quiñones MA, Greenberg BH, Kopelen HA, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. J Am Coll Cardiol. 2000; 35: 1237-1244.

11- Poelaert J and Roosens C. Is tissue doppler echocardiography ,the holy grail for the intensivist? Crit Care 2007;11:135.

12- Arques S, Roux E and Luccioni R.Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovascular Ultrasound 2007; 5:16.

14- Blessberger H, Binder T.Two dimensional speckle tracking echocardiography: basic principles,” Heart.2010; 96: 716-722. 15- Manovel A Dawson D, Smith of left Nihoyannopoulos.Assessment ventricular function by different speckle tracking software. Eur J Echocardiogr. 2010 Jun;11(5):417-21.

16- Rey C ,García-Hernández I, Concha A, et al. Pro-adrenomedullin, procalcitonin,

pro-endothelin-1, C-reactive

mortality risk in critically ill children: a

prospective study Critical Care 2013, 17:R240. protein and

17- Pepys MB.CRP or not CRP? Hat is the question. Arterioscler Thromb Vasc Biol 2005; 25: 1091-4.

18- Anand A, Kumar N ,Gambhir IS , et al. Role of serum Hs CRP as a prognostic marker in septicaemia in elderly population. Int J Med Sci Public Health. 2013;2(2): 290-292

19- Das S, Anand D, Ray S, et al. Role of procalcitonin and high sensitivity C- reactive protein in sepsis: a prospective study. Critical Care .2011;15(3):R25.

20- Moreno R, Vincent JL, Matos R, et al. The use of maximum SOFA score to quantify organ care.Results of a prospective , multicentre study.Intensive Care Med 1999;25:686-696