Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Sirico, Domenico; Basso, Alessia; Reffo, Elena; Cavaliere, Annachiara; Castaldi, Biagio; Sabatino, Jolanda; Meneghel, Alessandra; Martini, Giorgia; Dalt, Liviana Da; Zulian, Francesco; Salvo, Giovanni Di

doi:10.3390/jcm10153360

Cited by 46 publications

(67 citation statements)

References 35 publications

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“…In this scenario, an early control of inflammation may limit the disease's severity. Our hypothesis appears to be supported by early cardiac MRI and speckle tracking echocardiography abnormalities [34] suggesting a post-viral immune-mediated myocarditis-like pathogenesis rather than a virus-mediated process [35].…”

Section: Discussionsupporting

confidence: 61%

Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area

Fabi

Filice

Biagi

et al. 2021

Viruses

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SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.

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Section: Discussionsupporting

confidence: 61%

Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area

Fabi

Filice

Biagi

et al. 2021

Viruses

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“…It is likely, however, that MIS-C represents an important subset, with limited case series demonstrating widely varying rates of imaging abnormalities suggestive of myocarditis (0%-51%). 20 , 21 , 70 , 71 , 72 …”

Section: Description Of Pathwaymentioning

confidence: 99%

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Gluckman¹,

Bhave²,

Allen³

et al. 2022

Journal of the American College of Cardiology

295

273

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“…There have been several small studies to date evaluating CMR findings in patients with MIS-C, encompassing more than 130 patients. CMRs that were performed during the initial hospitalization or soon after discharge frequently identified myocardial edema on T 2 -weighted images, hyperemia and capillary leak (using T 1 -weighted images before and immediately after gadolinium administration), and LGE ( 72 , 73 , 74 , 75 , 76 , 77 ). However, in a few studies evaluating CMRs closer to 2 to 3 months after discharge, there were frequently no abnormalities ( 78 , 79 ).…”

Section: Multisystem Inflammatory Syndrome In Childrenmentioning

confidence: 99%

Cardiovascular Magnetic Resonance for Patients With COVID-19

Petersen

Friedrich

Leiner

et al. 2022

JACC: Cardiovascular Imaging

102

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COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19–related myocarditis is likely infrequent, COVID-19–related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post–COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19–related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.

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Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Cited by 46 publications

References 35 publications

Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area

Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Cardiovascular Magnetic Resonance for Patients With COVID-19

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