Cardiac Magnetic Resonance Findings after Multisystem Inflammatory Syndrome in Children

Dove, Matthew; Oster, Matthew E.; Hashemi, Sassan; Slesnick, Timothy C.

doi:10.1016/j.jpeds.2022.02.049

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…and Dove et.al. similar to our study did not report any myocardial edema but presence of LGE in 7.6% and 3.9% respectively (24,45). We postulate this presence of LGE during mid-term follow in these multiple single center studies represents scarring from previous myocardial injury, analogous to acute viral myocarditis.…”

Section: Discussionsupporting

confidence: 85%

“…Limited, single center studies have described almost complete resolution of ventricular systolic dysfunction and coronary artery changes within 3-6 months following discharge (15,(19)(20)(21). However, there is some evidence that subtle abnormalities in diastolic function on TTE and evidence of myocardial injury on cardiovascular magnetic resonance imaging (CMR) may persist longer (19)(20)(21)(22)(23)(24)(25). We have previously described the CMR results in a subset of patients at 6-month follow-up who had initial presentation with signi cant troponin leak and/or left ventricular systolic dysfunction (25).…”

Section: Introductionmentioning

confidence: 99%

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Long-term Cardiovascular Outcomes of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 using an Institution Based Algorithm

Chakraborty

Johnson

Spagnoli

et al. 2022

Preprint

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Background: Cardiovascular involvement is a major cause of inpatient and intensive care unit morbidity related to Multisystem inflammatory syndrome in children (MIS-C). The objective of this study was to identify long-term cardiovascular manifestations of MIS-C. Methods: We included 80 consecutive patients admitted to the intensive care unit with MIS-C who were evaluated for a year in our follow-up clinic using an institution protocol. The outcome measures were cardiac biomarkers (troponin and BNP), electrocardiogram changes, echocardiographic findings cardiovascular magnetic resonance (CMR) and graded-exercise stress test (GXT) findings. Results: The cohort included patients aged between 6 months and 17 years (median 9 years; 48.8% females). At the peak of the disease 81.3% had abnormal BNP and 58.8% had troponin leak which reduced to 33.8% and 18.8% respectively at discharge with complete normalization by 6 weeks post-discharge. At admission 33.8% had systolic dysfunction, which improved to 11.3% at discharge with complete resolution by 2 weeks. Coronary artery abnormalities were seen in 17.5% during the illness with complete resolution by 2 weeks post discharge except one (1.9%) with persistent giant aneurysm at 1 year-follow up. CMR was performed at 6 months in 23 patient and demonstrated 4 patients with persistent late gadolinium enhancement (17.4%). Normal exercise capacity with no ectopy was seen in the 31 qualifying patients that underwent a GXT.Conclusions: There is significant heterogeneity in the cardiovascular manifestations of MIS-C. Although majority of the cardiovascular manifestations resolve within 6 weeks, diastolic dysfunction, CAA and myocardial scar may persist in a small subset of patients warranting a structured long-term follow-up strategy.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Long-term Cardiovascular Outcomes of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 using an Institution Based Algorithm

Chakraborty

Johnson

Spagnoli

et al. 2022

Preprint

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“…Only one of nine patients had residual edema on cardiac MRI [ 24 ]. The recent study by Dove et al [ 25 ] detected late gadolinium enhancement, T1 mapping abnormalities, and abnormal or borderline extracellular volume calculations suggesting myocardial fibrosis in two of 51 patients, and no patient had T2 mapping abnormalities corresponding with edema. In our study, echocardiography did not show any abnormality at the 6th month (except coronary dilatation), whereas cardiac MRI demonstrated cardiac involvement, particularly pericardial effusion.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies demonstrated MIS-C-related ventricular dysfunction or CAD using standardized assessments. There are only five studies showing cardiac MRI findings in the early phase of MIS-C, and no studies on cardiac MRI findings in the late phase [21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Patients who received a follow-up CMR 2-12 months after diagnosis of viral or idiopathic myocarditis from January 2015 to December 2021 or 2-12 months after diagnosis of MIS-C from April 2020 to June 2021 were included for the comparison groups. CMR findings in a portion of the latter group were previously reported; the group was expanded to include additional patients to generate the comparator group used for the current study (10). We required negative COVID-19 PCR and IgG anti-nucleocapsid antibody testing for patients who experienced classic myocarditis in 2020 and later to qualify for inclusion in the classic myocarditis group.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Cardiac Magnetic Resonance Findings of COVID-19 Vaccine Associated Myocarditis at Intermediate Follow Up: a Comparison to Classic Myocarditis and MIS-C Related Myocarditis

Dove

Slesnick

Oster

et al. 2022

Preprint

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Objective: To report intermediate cardiac magnetic resonance (CMR) findings of COVID-19 vaccine associated myocarditis (C-VAM) and compare to classic myocarditis (CM) and multisystem inflammatory syndrome in children (MIS-C). Study Design: Retrospective cohort study including children diagnosed with C-VAM from 5/2021 through 12/2021 with early and intermediate CMR. Patients with CM and MIS-C with intermediate CMR were included for comparison. Results: There were 8 patients with C-VAM, 20 with CM, and 61 with MIS-C. Among those with C-VAM, CMR performed at median 3 days (IQR 3, 7) revealed 2/8 patients with left ventricular ejection fraction (LVEF)<55%, 7/7 patients with late gadolinium enhancement (LGE), and 5/8 patients with elevated native T1 values. Borderline T2 values suggestive of myocardial edema were present in 6/8. Follow-up CMRs performed at median 107 days (IQR 97, 177) showed normal ventricular systolic function, T1, and T2 values; 3/7 patients had LGE. At intermediate follow up the C-VAM group had a lower percentage of LVEF<55% compared to CM and MIS-C (0.0 vs 30.0 vs 6.6%, respectively, p=0.018) and an intermediate degree of LGE (42.9 vs 75.0 vs 3.3%, respectively, p<0.001). Pairwise comparisons showed fewer myocardial segments with LGE in the C-VAM group versus CM (4/119 vs 42/340, p=0.004) and more segments with LGE than MIS-C (4/119 vs 2/1020, p=0.0014). Conclusion: Patients with C-VAM had no evidence of active inflammation or ventricular dysfunction on intermediate CMR although a minority had persistent LGE. Intermediate findings in C-VAM may be favorable compared to CM though LGE is more common compared to MIS-C.

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Cardiac Magnetic Resonance Findings after Multisystem Inflammatory Syndrome in Children

Cited by 16 publications

References 26 publications

Long-term Cardiovascular Outcomes of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 using an Institution Based Algorithm

Long-term Cardiovascular Outcomes of Multisystem Inflammatory Syndrome in Children Associated with COVID-19 using an Institution Based Algorithm

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

Cardiac Magnetic Resonance Findings of COVID-19 Vaccine Associated Myocarditis at Intermediate Follow Up: a Comparison to Classic Myocarditis and MIS-C Related Myocarditis

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