Short-Term sequelae of Multisystem Inflammatory Syndrome in Children Assessed by CMR

Bermejo, Ivan Altamar; Bautista‐Rodriguez, Carles; Fraisse, Alain; Voges, Inga; Gatehouse, Peter; Kang, Heechan; Piccinelli, Enrico; Rowlinson, Giselle; Lane, Mary; Semple, Thomas; Moscatelli, Sara; Dwornik, Maria; Lota, Amrit; Salvo, Giovanni Di; Wage, Ricardo; Prasad, Sanjay; Mohiaddin, Raad H.; Pennell, Dudley J.; Thavendiranathan, Paladinesh; Krupičková, Sylvia

doi:10.1016/j.jcmg.2021.01.035

Cited by 21 publications

(32 citation statements)

References 3 publications

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“…A possible explanation might be the timing of CMR, which was carried out earlier (<11 days) in the case series as compared to our study. Consistently, a recent study describing CMR findings in 20 patients with MIS-C, reported normal T1 and T2 mean values and presence of LGE in only two (10%) patients [12]. Nevertheless, the mean time from fever onset to CMR was 27 ± 14 days, much longer than in our study.…”

Section: Cardiac Magnetic Resonancesupporting

confidence: 90%

“…Interestingly, respiratory viruses, such as influenza and coronaviruses, are examples of pathogens that can trigger an immunemediated lymphocytic myocarditis without evidence of a viral genome on endomyocardial biopsy [36]. Finally, the data regarding low mortality rate, rapid echocardiographic recovery and the absence of inflammation or LGE on CMR just a few weeks after disease onset, corroborate the hypothesis of an immune-mediated myocarditis-like damage in MIS-C population [11,12]. MIS-C may represent the missing physiopathologic link between KD and post-viral acute myocarditis, suggesting that virus-triggered immune-mediated reactions in susceptible hosts may represent the main cause of cardiomyocyte injury rather than actual direct virus-mediated cell injury, as previously hypothesized [37] (Figure 4).…”

Section: Physiopathologic Hypothesismentioning

confidence: 67%

“…Among the others, left ventricular (LV) systolic dysfunction is the most frequent cardiac abnormal finding. Latest evidence shows that myocardial dysfunction improves early after disease onset and that myocardial injury may not be appreciated on cardiac MRI just a few weeks after symptoms onset, suggesting an immune-mediated pathogenesis of such condition [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Sirico

Basso

Reffo

et al. 2021

JCM

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Multisystem Inflammatory Syndrome in Children (MIS-C) is a known severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the early cardiac abnormalities in patients with MIS-C, evaluated by speckle tracking echocardiography (STE) and cardiac MRI (CMR). Clinical, laboratory and microbiological data were measured for all patients. All children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS). Seventeen (75%) of the children were evaluated with CMR. Twenty-three patients (13M, 10F) were recruited, mean age was 8.1 ± 4 years. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission. In-hospital survival was 100%. TnI was elevated in 15 (65.2%) and BNP in 20 (86.9%) patients. The median time to STE evaluation was 8 days and to CMR was 18 days after fever onset. Mean LVEF was 59 ± 10%. Coronary dilation was observed in six (26.1%) patients. STE showed a reduced mean LVGLS (−17 ± 4.3%). LGE with a non-ischemic pattern was evident in six out of seventeen patients (35.2%). The elevation of myocardial necrosis markers, the reduction of LVGLS and the presence of LGE on CMR in about a quarter of MIS-C patients supports the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis.

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Section: Cardiac Magnetic Resonancesupporting

confidence: 90%

Section: Physiopathologic Hypothesismentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

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Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Sirico

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Reffo

et al. 2021

JCM

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“…Ventricular dysfunction is a common finding of MIS-C with 33–50% of patients affected [ 13 ••, 28 ••, 34 , 35 ]. Evidence for this includes elevated BNP levels and abnormalities of ventricular function on echocardiography and/or CMR [ 34 , 36 , 37 ]. The mechanism for the change in ventricular function appears to be multifactorial.…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

“…In this study, there were no findings of hyperenhancement by late gadolinium enhancement imaging [ 25 ]. Several studies have evaluated MIS-C patients by CMR after the acute illness (2–8 weeks after illness) [ 25 , 28 ••, 34 , 41 , 43 ]. Strain abnormalities have been noted by CMR and were seen most commonly in patients with reduced left ventricular ejection fraction [ 41 ].…”

Section: Cardiac Findings Of Mis-cmentioning

confidence: 99%

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Campbell

2021

Curr Cardiol Rep

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Purpose of Review To review the spectrum of cardiac manifestations and treatments of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Recent Findings Studies demonstrate that up to 80% of children with MIS-C may have cardiac involvement on a spectrum of severity. Cardiac manifestations include myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias. Current treatments, including inotropic support, immunomodulatory therapy, and anti-coagulation, have been effective at resolving these cardiac findings in the majority of patients. COVID-19 can also cause myocarditis in the acute stage of illness and recent descriptions of COVID-19 vaccine myocarditis have occurred. Summary Cardiac manifestations are common in MIS-C and should be assessed for at presentation and during the clinical course as indicated.

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Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID‐19

Tijmes

Marschner

Thavendiranathan

et al. 2023

Magnetic Resonance Imaging

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Globally, over 650 million people have had COVID‐19 due to infection with the SARS‐Cov‐2 virus. Cardiac complications in the acute infectious and early recovery phase were recognized early in the pandemic, including myocardial injury and inflammation. With a decrease in the number of acute COVID‐19 related deaths, there has been increased interest in postacute sequela of COVID‐19 (PASC) and other longer‐term cardiovascular complications. A proportion of patients recovered from COVID‐19 have persistent cardiac symptoms and are at risk of cardiovascular disease. Cardiovascular imaging, including MRI, plays an important role in the detection of cardiovascular manifestations of COVID‐19 in both the acute and longer‐term phases after COVID‐19. The purpose of this review is to highlight the role of cardiovascular imaging in the diagnosis and risk stratification of patients with acute and chronic cardiovascular manifestations of COVID‐19 with a focus on cardiac MRI. Evidence Level 4. Technical Efficacy Stage 3.

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Short-Term sequelae of Multisystem Inflammatory Syndrome in Children Assessed by CMR

Cited by 21 publications

References 3 publications

Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Early Echocardiographic and Cardiac MRI Findings in Multisystem Inflammatory Syndrome in Children

Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19

Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID‐19

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