Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction.

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

“…Notably, in our group of patients, while there was a trend for improvement in LV-GLS measurements, it was not statistically signi cant, probably due to the small sample size. Our ndings are consistent with those reported by other studies, that observed a normalization of the LV-GLS in the majority of MIS-C patients at a six-month follow-up, where the rates of participants with residual GLS impairment ranged from 0 to 13% [11,12,18].…”

“…In previous reports, decreased LVEF was more common, as it was present, during the acute illness, in 34.2-40% of children with MIS-C [14,16,35]. In line with the ndings of previous studies, that described a rapid improvement of LVEF, returning to normal by the rst days to weeks from admission, all the participants of our cohort, had preserved LVEF on follow-up [12,13].…”

“…In MIS-C, cardiovascular involvement is not only one of the most prominent features, but it is also a key determinant of illness severity, management, and prognosis [12,15]. To date, most published reports assess myocardial function in MIS-C with conventional echocardiography, while very few studies use advanced echocardiographic techniques like STE in a long-term follow-up of these patients [4,11,12,18].…”

“…However, the incidence of CAA in MIS-C varies among different studies and it is estimated to be at 6-24% [8,44]. These discrepancies could be a result of the overlap of MIS-C with KD, a delay in the diagnosis and treatment, demographic disparities of the study populations, the circulating SARS-CoV-2 variant, the use of different MIS-C diagnostic criteria and variabilities in the quality of the applied imaging techniques [12,15]. The underlying mechanism of CAA formation may also differ between KD and MIS-C [15,16].…”

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).…”