Midterm Outcomes and Cardiac Magnetic Resonance Imaging following Multisystem Inflammatory Syndrome in Children

Barris, David M.; Keelan, Jenna; Ahluwalia, Neha; Jhaveri, Simone; Cohen, Jennifer; Stern, Kenan W.D.; Seiden, Howard; Glass, Lauren

doi:10.1016/j.jpeds.2021.10.009

Cited by 24 publications

(24 citation statements)

References 19 publications

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“…In a study from the UK assessing myocardial deformation, strain values were significantly lower for patients with MIS-C than controls even though conventional CMR parameters were in the normal range [25]. A single-center study by Barris et al also found that patients had normal LVEF with no myocardial fibrosis at 9 months from illness [26]. There are few published studies that have assessed cardiac function by CMR after MIS-C; however, to our knowledge, only one prior study evaluated strain by CMR [25].…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 95%

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

et al. 2022

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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.

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Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 95%

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

et al. 2022

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“…We report the largest cohort of patients with MIS-C ( n = 21) who underwent CMR as a part of mid-term evaluation of cardiovascular outcomes. CMR as a part of 6-months evaluation has also been reported by Barris et al [ 16 ]. This study included CMR evaluation in 9 patients with median follow-up of 7 (IQR 6–8.4) months.…”

Section: Discussionmentioning

confidence: 53%

“…Limited, single-center retrospective studies have demonstrated that although systolic ventricular dysfunction function and coronary artery abnormalities almost always recover within 3–6 months, subtle abnormalities in diastolic function possibly reflective of myocardial injury persist in a subset of patients [ 13 – 15 ]. In addition, Barris et al demonstrated persistent abnormal T2-weighted signal ratio in 44% of the patients when cardiovascular magnetic resonance (CMR) was performed around 6 months after diagnosis of MIS-C [ 16 ]. Evidence of subtle myocardial injury is significant, considering that majority of these patients have no previous cardiovascular history.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Magnetic Resonance in Children with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: Institutional Protocol-Based Medium-Term Follow-up Study

et al. 2022

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Multisystem inflammatory syndrome in children (MIS-C) secondary to COVID-19 infection in previously healthy children often results in subtle but persistent echocardiographic abnormalities despite complete clinical recovery. This study was done to investigate medium-term cardiovascular outcomes of patients with MIS-C using cardiovascular magnetic resonance imaging (CMR). This is a single-center retrospective study of patients aged less than 21 years, diagnosed with MIS-C who received an outpatient CMR, around 6 months after discharge. CMR was done in patients with significant troponin leak or depressed LVEF. CMR performed on a GE Signa HDxt 1.5 Tesla magnet with a myocarditis protocol. Diagnosis of myocarditis was determined by the original Lake Louise Criteria. There were 21 patients with a median age of 11 years, (IQR 8–13 years), who underwent CMR at median follow-up duration of 6 months (IQR 5–7 months). At the peak of illness during admission, there were 95.2% patients with abnormal Troponin I and BNP. By echocardiogram, 76.2% had left ventricular systolic dysfunction and 9.5% had coronary ectasia, which all resolved by 6 months. By CMR, there were five patients (23.8%) with abnormal left atrial volume, one patient (4.8%) with an abnormal indexed left ventricular end-diastolic volume, and three patients (15%) with abnormal LVEF. There was no evidence of myocardial edema in T2-weighted image sequence. There were three patients with persistent late gadolinium enhancement (14.3%). Follow-up CMR is a useful tool in diagnosing subtle myocardial abnormalities and guide necessity for future follow-up.

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“…Since our last publication on mid-term CMR results from the same cohort, CMR was available in 3 more patients (25) (24,44,45). Myocardial edema on T2 weighted image was reported by Barris et.al in 44%, the reason for this large number of patients having persistent abnormal T2 weighted signal ratio, long after initial insult is unclear (44). In contrast, Dilorenzo et.al.…”

Section: Discussionmentioning

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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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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Midterm Outcomes and Cardiac Magnetic Resonance Imaging following Multisystem Inflammatory Syndrome in Children

Cited by 24 publications

References 19 publications

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

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

Cardiovascular Magnetic Resonance in Children with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: Institutional Protocol-Based Medium-Term Follow-up Study

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

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