Longitudinal Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

Yasuhara, Jun; Masuda, Kaihei; Watanabe, Kae; Shirasu, Takuro; Takagi, Hisato; Sumitomo, Naokata; Lee, Simon; Kuno, Toshiki

doi:10.1007/s00246-022-03052-2

Cited by 14 publications

(9 citation statements)

References 62 publications

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“…The results of our study are in line with most of the previous findings and show that valvular insufficiency and myocardial dysfunction are the most common cardiological findings in children with MIS-C. The median LVEF in our study (55%) was comparable with the results presented in the meta-analysis of the studies concentrating on longitudinal cardiac outcomes in MIS-C (54%) [47]. IMV was slightly less common in our study (42.8% vs. 56.6%) and CAAs were definitively less common (10.5% vs. 23.7%) [47].…”

Section: Discussionsupporting

confidence: 92%

“…The median LVEF in our study (55%) was comparable with the results presented in the meta-analysis of the studies concentrating on longitudinal cardiac outcomes in MIS-C (54%) [47]. IMV was slightly less common in our study (42.8% vs. 56.6%) and CAAs were definitively less common (10.5% vs. 23.7%) [47]. Such a discrepancy in the frequency of CAAs was noted before in our population [37] and may be explained by ethnic differences.…”

Section: Discussionsupporting

confidence: 89%

“…Most of the studies presenting the acute phase of MIS-C concentrated on the values of LVEF at a single time point [15,17,32,46,49], while the studies with follow-ups presented the results from an interval of at least 2 weeks to a few months [30,47,[51][52][53][54]. They all reported a significant improvement in children who had myocardial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

et al. 2023

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Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the study was to characterise the course of MIS-C with a focus on cardiovascular involvement, based on echocardiographic (echo) evaluation, in 498 children (median age 8.3 years, 63% boys) hospitalised in 50 cities in Poland. Among them, 456 (91.5%) had cardiovascular system involvement: 190 (48.2%) of patients had (most commonly atrioventricular) valvular insufficiency, 155 (41.0%) had contractility abnormalities and 132 (35.6%) had decreased left ventricular ejection fraction (LVEF < 55%). Most of these abnormalities improved within a few days. Analysis of the results obtained from two echo descriptions (a median of 5 days apart) revealed a >10% increase in LVEF even in children with primarily normal LVEF. Lower levels of lymphocytes, platelets and sodium and higher levels of inflammatory markers on admission were significantly more common among older children with contractility dysfunction, while younger children developed coronary artery abnormality (CAA) more often. The incidence of ventricular dysfunction might be underestimated. The majority of children with AHF improved significantly within a few days. CAAs were relatively rare. Children with impaired contractility as well as other cardiac abnormalities differed significantly from children without such conditions. Due to the exploratory nature of this study, these findings should be confirmed in further studies.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

et al. 2023

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“…Finally, a systematic review and meta-analysis performed by Yasuhara et al revealed the longitudinal cardiac outcomes in MIS-C patients based on their mid-term (>3 months) follow-ups. The authors emphasized the importance of follow-up with these patients, observing a decrease in the rate of LV systolic dysfunction (from 46.8% at admission to 1.7% after 3 months and 2.1% after 6 months), coronary abnormalities (from 23.7% to 4.7% and 5.2%, in 3 and 6 months, respectively), and mitral regurgitation (from 56.6% to 7.5% at the 6th month) [58].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Mileva,

Vasilev,

Ganev

et al. 2023

Medicina

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Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.

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“…Regarding children hospitalized with MIS-C, the impairments described for this cohort represent sequelae of a post-infectious complication of COVID, which is not considered “long COVID” but remains an important outcome for children infected with SARS-CoV-2. While cardiac abnormalities are likely to resolve during the post-acute recovery period, the trajectory of the multisystem impairments requires further investigation ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C

Maddux,

Young,

Kucukak

et al. 2023

Front. Pediatr.

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ObjectiveTo identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.MethodsAcross 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).ResultsOf 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n= 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.DiscussionAmong patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.

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Longitudinal Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children: A Systematic Review and Meta-Analysis

Cited by 14 publications

References 62 publications

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Cardiac Involvement in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) in Poland

Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C

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