Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

Abstract

Objectives: We aim to describe the early and upto 16 months follow-up of post-coronavirus disease (COVID), multi-system inflammatory syndrome in children (MIS-C), with special reference to cardiac involvement. Study design: This cohort non-interventional descriptive study included patients <18 years admitted between May, 2020 and April, 2021. Based on underlying similarities, children were classified as post-COVID MIS-C with overlapping Kawasaki Disease, MIS-C with no overlapping Kawasaki Disease, and MIS-C with shock. Post-discharge, patients were followed at 1, 3, 6, 12, and 16 months. Results: Forty-one patients predominantly males (73%), at median age of 7 years (range 0.2–16 years) fulfilled the World Health Organisation criteria for MIS-C. Cardiac involvement was seen in 15 (36.5%); impaired left ventricle (LV) function in 5 (12.2%), coronary artery involvement in 10 (24.4%), pericardial effusion in 6 (14.6%) patients, and no arrhythmias. There were two hospital deaths (4.9%), both in MIS-C shock subgroup (2/10, 20%). At 1 month, there was persistent LV dysfunction in 2/5, coronary artery abnormalities in 7/10, and pericardial effusion resolved completely in all patients. By 6 months, LV function returned to normal in all but coronary abnormalities persisted in two patients. At last follow-up (median 9.8 months, interquartile range 2–16 months), in 36/38 (94.7%) patients, coronary artery dilatation was persistent in 2 (20%) patients. Conclusions: Children with MIS-C have a good early outcome, though MIS-C with shock can be life-threatening subgroup in a resource-constrained country setting. On midterm follow-up, there is normalisation of LV function in all and recovery of coronary abnormalities in 80% of patients.

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

“…After title and abstract screening, 190 full-text articles were assessed for eligibility and 179 articles were excluded based on lack of inclusion criteria such as the article type (editorials, reviews, systematic reviews, and meta-analyses), population (adult patients with COVID-19, cases without meeting the case definition for MIS-C), and articles without mid-term or long-term outcomes. Finally, 11 observational studies [ 15 – 20 , 27 – 31 ] were included in our meta-analysis (Fig. 1 ).…”

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

“…and Penner et. al (23,38). Importantly, our study shows that cardiac biomarkers and abnormal left ventricular function do not predict neither development of coronary artery abnormalities nor their persistence.…”

“…Similar to our results, the coronary artery involvement has been described as dilation or mild aneurysm in most of the published studies. Giant aneurysm although extremely rare, have been described (14,23,37,38). Feldstein et.…”

“…The natural history of this persistent systolic dysfunction is available in only a handful of studies. (19,23,24) Most of the other studies describe near complete resolution of myocardial dysfunction with 4-18 days at the time of discharge (7,13,14,17,35,36). Our study speci cally investigates the natural history of the myocardial dysfunction.…”

“…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).…”