Echocardiographic Findings and Correlation with Laboratory Values in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

Abstract

Cardiac involvement is a common and serious problem in multisystem inflammatory syndrome in children (MIS-C). Echocardiographic evaluation of systolic and diastolic function by traditional, tissue Doppler and three-dimensional (3D) echocardiography was performed in consecutive 50 MIS-C patients during hospitalization and age-matched 40 healthy controls. On the day of worst left ventricular (LV) systolic function (echo-1), all left and right ventricular systolic function parameters were significantly lower ( p < 0.001), E/A ratio was significantly lower, and averaged E/e′ ratio was significantly higher (median 1.5 vs. 1.8, p < 0.05; 8.9 vs. 6.3, p < 0.001 respectively) in patients compared to control. Patients were divided into 2 groups according to 3D LV ejection fraction (LVEF) on the echo-1: Group 1; LVEF < 55%, 26 patients, and group 2; LVEF ≥ 55%, 24 patients. E/e′ ratio was significantly higher in group 1 than group 2 and control at discharge (median 7.4 vs. 6.9, p = 0.005; 7.4 vs. 6.3, p < 0.001 respectively). Coronary ectasia was detected in 2 patients (z score: 2.53, 2.6 in the right coronary artery), and resolved at discharge. Compared with group 2, group 1 had significantly higher troponin-I (median 658 vs. 65 ng/L; p < 0.001), NT-pro BNP (median 14,233 vs. 1824 ng/L; p = 0.001), procalcitonin (median 10.9 vs. 2.1 µg/L; p = 0.009), ferritin (median 1234 vs. 308 µg/L; p = 0.003). The most common findings were ventricular systolic dysfunction recovering during hospitalization, and persisting LV diastolic dysfunction in the reduced LVEF group at discharge. Coronary artery involvement was rare in the acute phase of the disease. Also, in MIS-C patients, the correlation between LV systolic dysfunction and markers of inflammation and cardiac biomarkers should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s00246-021-02738-3.

Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features

“…In previous studies, pericardial effusion has been shown in 9–72% of MIS-C patients [ 19 , 35 , 36 ]. Valverde et al [ 19 ] reported 80 (27.9%) patients with pericardial effusion at admission, 66 (25%) of them being mild, 8 (3%) of them moderate.…”

“…A previous study determined 50% mitral regurgitation and 72% pericardial effusion via echocardiography among MIS-C patients on admission, while only 20% had small pericardial effusion and 18% had mild mitral regurgitation at discharge [ 36 ]. Valverde et al [ 19 ] reported the rate of mitral regurgitation and tricuspid regurgitation in a large European MIS-C cohort as 42.5% and 5.9%, respectively.…”

“…Valverde et al [ 19 ] showed coronary artery abnormalities in 69 (24.1%) of the 286 patients and giant aneurysm in 1 (0.3%) patient. Coronary artery ectasia ( Z score: 2.53 and 2.6 in the right coronary artery) was detected in only two patients (4%) in one of the previous studies and they recovered until discharge [ 36 ]. Similar to these studies, coronary artery abnormalities were detected in 14.7% of patients in our study.…”

COVID-19 in Children

“…61 , 68 The incidence of coronary artery dilation and aneurysms (CAA) in MIS-C is four to twenty four percent. 60 , 61 , 72 , 73 , 74 In patients with KD, the risk of coronary artery thrombosis is directly related to size of CAA and increases exponentially above a z-score of 10. 75 , 76 Depressed left ventricular function (LV) has been noted in a third of patients.…”

CXCL10/IP10 as a Biomarker Linking Multisystem Inflammatory Syndrome and Left Ventricular Dysfunction in Children with SARS-CoV-2

“…Furthermore, some parameters, such as osteopontin and endothelial glycocalyx degradation, have been suggested as biomarkers for distinguishing severe COVID-19 and MIS-C patients from mild/asymptomatic children with COVID-19 [ 15 , 16 ]. Kavurt et al [ 17 ] evaluated the correlation between cardiac involvement and laboratory parameters and found that LV systolic dysfunction was associated with increased levels of troponin-I, NT-pro BNP, procalcitonin, and ferritin. Chang et al [ 18 ] reported a correlation between impaired global longitudinal strain values and increased levels of IL-6 and IL-8.…”