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

Abstract

Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2-4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2-6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients' MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2-6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.

Evaluation of Multisystem Inflammatory Syndrome in Children (MIS-C) Cases: Clinical Features and Cardiologic Findings

“…It has been reported that patients with hypotension, shock, and myocarditis are admitted to the ICU more frequently than patients with coronary dilatation/aneurysm (7,10,11,22,23). Laboratory tests show that pro-BNP and troponin levels are higher during ICU admission (10)(11)(22)(23). In our study, no difference was found between the patients with and without cardiac involvement in relation to ICU admission.…”

“…The American College of Rheumatology recommended that all patients be evaluated by echocardiography and cardiac MRI no earlier than 2-6 months after diagnosis to determine the long-term cardiac effects of MIS-C cases (24) (22). Similarly, in our study, cardiac MRI was performed in only 4 of 31 patients 6 months after discharge, and no cardiac pathology was detected in 4 patients.…”

“…The most common cardiac finding was left ventricular dysfunction, which is also found in the literature, whereas coronary dilatation was less common. It has been reported that patients with hypotension, shock, and myocarditis are admitted to the ICU more frequently than patients with coronary dilatation/aneurysm (7,10,11,22,23). Laboratory tests show that pro-BNP and troponin levels are higher during ICU admission (10)(11)(22)(23).…”

The influence of maternal COVID‐19 on cardiac functions: From fetal life to infancy

“…Thirty‐six healthy pregnant women who had COVID‐19 infection with mild to moderate symptoms according to The National Institutes of Health (NIH) classification in the second trimester of pregnancy were included in the patient group (COVID group) 10,11 . Infection was confirmed with a reverse transcription‐polymerase chain reaction (RT‐PCR) test with a nasopharyngeal swab in all patients and none of them were hospitalized.…”

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).…”