Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019

Sanil, Yamuna; Misra, Amrit; Safa, Raya; Blake, Jennifer; Eddine, Ahmad Charaf; Balakrishnan, Preetha L.; Garcia, Richard U.; Taylor, Rachel A.; Dentel, John N.; Ang, Jocelyn Y.; Cashen, Katherine; Heidemann, Sabrina M.; Bauerfield, Christian; Sethuraman, Usha; Farooqi, Ahmad; Aggarwal, Sanjeev; Singh, Gautam K.

doi:10.1016/j.echo.2021.04.018

Cited by 44 publications

(64 citation statements)

References 28 publications

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“…We had only one patient with persistent 1st degree AV block after discharge that required prolonged aspirin therapy. The long-term cardiac sequelae of patients diagnosed along the spectrum of severity of MIS-C are yet to be determined [ 26 – 28 ], and chronic follow-up with Pediatric Cardiology is planned for our cohort.…”

Section: Discussionmentioning

confidence: 99%

A descriptive study on multisystem inflammatory syndrome in children in a single center in West Michigan

et al. 2021

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Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare hyperinflammatory condition that occurs following SARS-CoV-2 infection. There is a paucity of research describing risk factors, optimal management, and outcomes of this life-threatening condition. Methods This is a case series of 26 patients diagnosed with MIS-C in a West Michigan pediatric tertiary care center from April 2020 to February 2021. We describe the clinical, imaging, and laboratory characteristics of these patients and detail their treatments and outcomes with comparisons between Pediatric Intensive Care Unit (PICU) and non-PICU patients. Categorical testing utilized Chi-square and Fisher’s Exact tests. Comparison between groups used T-tests or Kruskal-Wallis. Results Fifteen patients (57%) required intensive care. There was no statistically significant difference in demographics between PICU and non-PICU patients, however all Black patients required intensive care. Gastrointestinal symptoms were present in 22 patients (84%). Seventeen patients (65%) had Kawasaki-like features and 12 (46%) developed coronary artery dilation. Patients requiring intensive care were less likely to have a reported history of COVID-19 disease or exposure (p = 0.0362). Statistically significant differences were also noted in peak ferritin (p = 0.0075), procalcitonin, and BNP in those who required intensive care. Conclusions Although overlap exists with other hyperinflammatory conditions, our study provides further evidence that MIS-C is a distinct, albeit heterogenous, disorder with various degrees of cardiac involvement. Anakinra, in conjunction with steroid use, appears to be effective and safe in the treatment of MIS-C. This report identifies procalcitonin, peak ferritin, and BNP as potentially useful biomarkers for severity of disease.

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Section: Discussionmentioning

confidence: 99%

A descriptive study on multisystem inflammatory syndrome in children in a single center in West Michigan

et al. 2021

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“…Ventricular dysfunction is a common finding of MIS-C with 33–50% of patients affected [ 13 ••, 28 ••, 34 , 35 ]. Evidence for this includes elevated BNP levels and abnormalities of ventricular function on echocardiography and/or CMR [ 34 , 36 , 37 ]. The mechanism for the change in ventricular function appears to be multifactorial.…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

“…In some cohorts, lower strain values are more frequent than a reduction in left ventricular ejection fraction and can be seen in patients with a normal left ventricular ejection fraction [ 37 ]. Decreased strain values are predictive of worse clinical outcomes [ 36 , 37 ]. Two studies reported frequent reductions of longitudinal strain, while another reported a pattern of abnormal circumferential strain with preserved longitudinal strain [ 36 , 37 , 42 ].…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

“…Decreased strain values are predictive of worse clinical outcomes [ 36 , 37 ]. Two studies reported frequent reductions of longitudinal strain, while another reported a pattern of abnormal circumferential strain with preserved longitudinal strain [ 36 , 37 , 42 ]. Abnormalities of diastolic dysfunction as measured by spectral and tissue Doppler and strain have also been noted [ 40 , 41 ].…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

“…A reduction in left ventricular ejection fraction is the most commonly reported finding, occurring in 34-50% of children with MIS-C [13••, 26•, 28••, 34,37,40,41]. Echocardiographic strain studies have indicated abnormal ventricular strain [36,37,[40][41][42]. In some cohorts, lower strain values are more frequent than a reduction in left ventricular ejection fraction and can be seen in patients with a normal left ventricular ejection fraction [37].…”

Section: Ventricular Dysfunctionmentioning

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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Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C)

Leone

Frye

et al. 2022

Pediatr Cardiol

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Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14-42, and > 42 days, respectively). Mean GLS improved from − 18.4% in the acute phase to − 20.1% in the chronic phase (p = 0.4). Mean GCS improved from − 19.4% in the acute phase to − 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events. KeywordsCoronavirus disease 2019 (COVID-19) • Multisystem inflammatory syndrome in children (MIS-C) • Twodimensional speckle tracking echocardiography (2D-STE) • Longitudinal strain • Circumferential strain Abbreviations MIS-C Multisystem inflammatory syndrome in children COVID-19 Coronavirus disease 2019 2D-STE Two-dimensional speckle tracking echocardiography GLS Global longitudinal strain GCS Global circumferential strain RLS Regional longitudinal strain RCS Regional circumferential strain FS Fractional shortening KD Kawasaki disease PICU Pediatric intensive care unit * Michael He

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Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019

Cited by 44 publications

References 28 publications

A descriptive study on multisystem inflammatory syndrome in children in a single center in West Michigan

A descriptive study on multisystem inflammatory syndrome in children in a single center in West Michigan

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

Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C)

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