Longitudinal Assessment of Cardiac Function Following Multisystem Inflammatory Syndrome in Children Associated with COVID-19

Abstract

Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 is commonly associated with cardiac involvement. Studies found myocardial dysfunction, as measured by decreased ejection fraction and abnormal strain, to be common early in illness. However, there is limited data on longitudinal cardiac outcomes. We aim to describe the evolution of cardiac findings in pediatric MIS-C from acute illness through at least 2-month follow-up. A retrospective single-center review of 36 patients admitted with MIS-C from April 2020 through September 2021 was performed. Echocardiographic data including cardiac function and global longitudinal strain (GLS) were analyzed at initial presentation, discharge, 2-4-week follow-up, and at least 2-month follow-up. Patients with mild and severe disease, normal and abnormal left ventricular ejection fraction (LVEF), and normal and abnormal GLS at presentation were compared. On presentation, 42% of patients with MIS-C had decreased LVEF < 55%. In patients in whom GLS was obtained (N = 18), 44% were abnormal (GLS < |− 18|%). Of patients with normal LVEF, 22% had abnormal GLS. There were no significant differences in troponin or brain natriuretic peptide between those with normal and abnormal LVEF. In most MIS-C patients with initial LVEF < 55% (90%), LVEF normalized upon discharge. At 2-month follow-up, all patients had normal LVEF with 21% having persistently abnormal GLS. Myocardial systolic dysfunction and abnormal deformation were common findings in MIS-C at presentation. While EF often normalized by 2 months, persistently abnormal GLS was more common, suggesting ongoing subclinical dysfunction. Our study offers an optimistic outlook for recovery in patients with MIS-C and carditis, however ongoing investigation for longitudinal effects is warranted.

Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

“…Abnormal strain measurements with preserved LVEF, during the acute phase of MIS-C and in different follow-up periods, have been also described in previous studies [ 4 , 17 , 23 , 41 ]. The above findings are suggestive of subclinical myocardial injury, that can be recognized with STE with LV-GLS analysis, but not with conventional echocardiographic parameters like the LVEF [ 11 ].…”

“…Specifically, we found that during the acute phase, LV-GLS was impaired in 42.9% of the patients, while LVEF was normal in all but one of these patients. In MIS-C, LV dysfunction, identified by LV-GLS, during the acute illness, has been reported in other studies, where the rate of GLS impairment was estimated at 44–65% [ 23 , 40 ]. Study data from mid-term echocardiographic follow-up evaluation (approximately at 2 months), report that while LV-GLS was improved in most patients, there was a persistence of GLS abnormalities in 21–24% of MIS-C patients [ 10 , 23 ].…”

“…In MIS-C, LV dysfunction, identified by LV-GLS, during the acute illness, has been reported in other studies, where the rate of GLS impairment was estimated at 44–65% [ 23 , 40 ]. Study data from mid-term echocardiographic follow-up evaluation (approximately at 2 months), report that while LV-GLS was improved in most patients, there was a persistence of GLS abnormalities in 21–24% of MIS-C patients [ 10 , 23 ]. Upon long-term follow-up (range: 5–18 months), although all children had normal LVEF, in one patient we detected persistence of the GLS impairment.…”

Longitudinal Cardiac Evaluation of children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

“…Abnormal strain measurements with preserved LVEF, during the acute phase of MIS-C and in different follow-up periods, have been also described in previous studies [4,17,23,37]. The above ndings are suggestive of subclinical myocardial injury, that can be recognized with STE with LV-GLS analysis, but not with conventional echocardiographic parameters like the LVEF [11].…”

Outpatient monitoring of patients with multisystem inflammatory syndrome (MIS-C): A mini review

“…There were 206 publications that resulted with our keyword search on MIS-C and follow-up between 2020 and 2022. Eleven published studies fit the inclusion criteria with a total of 343 participants (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). All studies included patients who met criteria for MIS-C per the CDC guidelines (see Figure 1).…”