Cardiovascular magnetic resonance imaging in children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 and heart dysfunction

Prieto, Luís; Toral, Belén; Llorente, Ana María Pinto; Coca, David Méndez; Blázquez‐Gamero, Daniel

doi:10.1016/j.cmi.2020.10.005

Cited by 13 publications

(17 citation statements)

References 5 publications

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“…In this study, there were no findings of hyperenhancement by late gadolinium enhancement imaging [ 25 ]. Several studies have evaluated MIS-C patients by CMR after the acute illness (2–8 weeks after illness) [ 25 , 28 ••, 34 , 41 , 43 ]. Strain abnormalities have been noted by CMR and were seen most commonly in patients with reduced left ventricular ejection fraction [ 41 ].…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

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Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Campbell

2021

Curr Cardiol Rep

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Purpose of Review To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Recent Findings Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred. Summary Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.

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Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

“…Areas of hyperenhancement are uncommon on late gadolinium enhancement, occurring in 0–14% of patients scanned (Fig. 1 ) [ 28 ••, 34 , 41 , 43 ]. Abnormalities of T2 and T1 have been noted in 0–33% and 0–5% of MIS-C patients, respectively [ 28 ••, 34 , 41 , 43 ].…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Campbell

2021

Curr Cardiol Rep

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“… 1 , 2 , 5 A few small case reports with cardiac magnetic resonance imaging (MRI) performed 1–4 weeks since hospital admission or initial symptoms have reported conflicting results. 6 , 7 , 8 One small case series demonstrated diffuse myocardial edema with no evidence of replacement fibrosis or focal necrosis. 6 A study on 20 children found myocardial edema in 50% of cases with three cases of speckling late gadolinium enhancement (LGE) and one subendocardial scar typical of ischemic injury.…”

mentioning

confidence: 99%

“… 9 Currently, to establish the true rate of potential cardiac complications post PIMS‐TS, most centers recommend follow‐up cardiac MRI to be performed 3 months after the presentation, but these data are currently lacking. 5 , 6 , 7 , 8 , 10 Follow‐up data are also needed to indirectly analyze the etiology of cardiac involvement in PIMS‐TS as lack of persistent cardiac changes would support inflammatory reaction to the virus as etiology of PIMS‐TS rather than direct myocardial injury by the SARS‐CoV‐2. With typical “pre‐SARS‐CoV‐2 era” myocarditis with direct myocardial injury by the virus, persistent fibrosis, or even signs of persistent acute myocarditis have been demonstrated in a subset of children even at 3–9 months follow‐up.…”

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confidence: 99%

Cardiac Magnetic Resonance Follow‐Up of Children After Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS‐CoV‐2 With Initial Cardiac Involvement

Bartoszek

Małek

Barczuk-Falęcka

et al. 2021

Magnetic Resonance Imaging

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Background Pediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) is an inflammatory disease occurring in a small minority of children a few weeks after acute infection. Cardiac manifestations are common, but little is known about the potentially persistent heart changes after PIMS‐TS. Purpose To analyze the frequency and type of myocardial complications of PIMS‐TS with initial cardiac involvement assessed with cardiac magnetic resonance imaging (MRI), including parametric imaging, performed 3 months after hospitalization. Study Type Retrospective. Population Nineteen consecutive children (median age 10 years, interquartile range (IQR) 10–15 years, 74% male). Field Strength/Sequence Balanced steady state free precession (bSSFP, cine imaging), modified Look‐Locker (T1 mapping), T2‐prepared bSSFP (T2‐mapping), dark‐blood T2‐weighted turbo spin echo with fat suppression and phase sensitive inversion recovery (late gadolinium enhancement (LGE)) sequences at 1.5 T. Assessment Patients were scanned after a median of 99 days (IQR 89–104 days) from the diagnosis. MR data were reviewed by three independent observers, with 13, 2, and 5 years' experience in cardiac MRI. Pre‐ and post‐contrast T1, T2, extra‐cellular volume, and T2 signal intensity (T2 SI) ratio were calculated. Diagnosis of acute myocarditis was based on modified Lake Louise criteria. Cardiac MRI parameters were compared, where possible, to previously published pediatric normal values. Statistical Tests Interclass correlation coefficient and Bland–Altman repeatability analysis. A P ‐value <0.05 was considered statistically significant. Results Despite cardiac involvement including decreased left ventricular ejection fraction (LVEF) (median LVEF = 47%, IQR 43%–53%) and increased troponin I (median 101 ng/mL, IQR 50–661 ng/mL) during hospitalization, there were no persistent cardiac changes observed in cardiac MR at follow‐up. All patients had normal size and function of the left ventricle and normal precontrast T1 and T2 relaxation times. There were no signs of LGE. Persistent, mild pericardial effusion (8–9 mm) was found in three (16%) patients. Data Conclusion There were no persistent changes on cardiac MRI in a group of children approximately 3 months post hospitalization due to PIMS‐TS with cardiac involvement. This supports the hypothesis that cardiac involvement during PIMS‐TS is a form of transient inflammatory response rather than direct and potentially persistent injury from the virus. Level of Evidence 4 Technical Efficacy Stage 3

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“…Cardiac CT scan can provide accurate evaluation of the coronary artery anatomy and may be considered in patients with difficult acoustic windows or with extensive coronary involvement. Cardiac magnetic resonance imaging may be useful during the initial hospitalization or approximately 3 mo post-acute illness to evaluate ventricular function and myocardial characteristics including edema, diffuse fibrosis, and scar by myocardial late gadolinium enhancement[ 42 , 43 ].…”

Section: Methodsmentioning

confidence: 99%

Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review

Ferrero¹,

Piazza²

2021

WJR

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Cardiovascular magnetic resonance imaging in children with pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 and heart dysfunction

Cited by 13 publications

References 5 publications

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Cardiac Magnetic Resonance Follow‐Up of Children After Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS‐CoV‐2 With Initial Cardiac Involvement

Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review

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