Investigation of endothelial dysfunction and arterial stiffness in multisystem inflammatory syndrome in children

Abstract

Severe acute respiratory syndrome coronavirus 2 infection can result in multisystem inflammatory syndrome in children (MIS-C). MIS-C can lead to myocardial dysfunction, heart failure, and multiorgan failure; the primary finding is hyperinflammation. Endothelial dysfunction has not been evaluated in patients with MIS-C. We investigated endothelial dysfunction and arterial stiffness parameters in patients with MIS-C. The study included 38 pediatric patients (20 males and 18 females aged 4-17 years, mean age 8.89 years) with MIS-C. Thirty-eight age-and sex-matched healthy individuals were enrolled as the control group. Systolic and diastolic ventricular measurements and systolic and diastolic measurements of ascending aorta diameter were performed by M-mode echocardiography. Endothelial dysfunction was evaluated using flow-mediated dilation by measuring the brachial artery diameter with a high-resolution probe. The MIS-C group had lower flow-mediated dilation than did the controls. The MIS-C group had decreased aortic strain and aortic distensibility values and correlations between decreased flowmediated dilation and reduced aortic strain, aortic distensibility, and reduced ejection fraction. Conclusion:The results show that patients with MIS-C had endothelial dysfunction and arterial stiffness. Furthermore, the degree of endothelial dysfunction correlated with reduced ejection fractions. What is Known:•Endothelial dysfunction and arterial stiffness are unknown in patients with MIS-C.•The effect of endothelial dysfunction and arterial stiffness on decreased cardiac function is unknown. What is New: •MIS-C patients have endothelial dysfunction and arterial stiffness.•There is a link between left ventricular dysfunction and reduced endothelial dysfunction in patients with MIS-C.

Persistent Endothelial Dysfunction in Post-Acute COVID-19 Syndrome: A Case-Control Study

“…In two previous studies [53,54], significantly lower FMD values were reported in COVID-19 patients during the acute phase as compared to healthy adults, with a value of ≤3.43% predicting mortality and longer hospital stay. Similar results were also found in a pediatric population [55]. While these studies focused on the acute phase of the disease, a previous report on 27 COVID-19 patients and 9 controls suggested the presence of persistently impaired FMD three months after virus positivity was given [36].…”

Acute and Long-Term Consequences of COVID-19 on Arterial Stiffness—A Narrative Review

“…Although COVID-19 infection in children is usually mild, some patients develop MIS-C (multisystem inflammatory syndrome in children), a late complication hallmarked by hyperinflammation, fever and multiorgan dysfunction. Ciftel et al [ 5 ] found that two echocardiography derived arterial stiffness markers (aortic strain and distensibility) were lower in MIS-C versus controls ( p < 0.01). Interestingly, brachial FMD was correlated with markers of arterial stiffness and left ventricular systolic function [ 5 ].…”

“…Ciftel et al [ 5 ] found that two echocardiography derived arterial stiffness markers (aortic strain and distensibility) were lower in MIS-C versus controls ( p < 0.01). Interestingly, brachial FMD was correlated with markers of arterial stiffness and left ventricular systolic function [ 5 ].…”

“…From a macrovascular perspective, evidence suggests that COVID-19 causes early vascular aging [ 5 ]. COVID-19-induced mitochondrial dysfunction, increased local production of reactive oxygen species (ROS) and subsequent oxidative telomere shortening have been proposed as other potential causes of cellular senescence and vascular stiffening [ 71 ].…”

“…Arterial stiffening, although naturally associated with aging, can be accelerated by associated respiratory, metabolic and cardiovascular comorbidities ( Figure 1 ) [ 4 ]. The chronic increase in afterload precipitates left ventricular remodeling and the development of heart failure [ 5 ]. As such, arterial stiffness and the modern concept of early vascular aging have been introduced as major determinants of vascular health.…”