Takotsubo syndrome as a cardiac manifestation of multisystem inflammatory syndrome in children

Ludwikowska, Kamila; Tracewski, Paweł; Kusa, Jacek

doi:10.1017/s1047951121004881

Cited by 5 publications

(10 citation statements)

References 9 publications

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“…Such a strong inflammatory reaction can be seen as a sufficient trigger for the occurrence of TTS. Belhadjer mentioned an echocardiographic image resembling TTS in a patient with acute heart failure in the course of MIS-C [14]; we have also described a similar case before [29]. In this analysis, we extracted the cases with a description of apex rounding or other segmental contractility abnormality.…”

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: Discussionmentioning

confidence: 99%

“…The acute and reversible nature of the heart failure in the course of MIS-C might resemble the picture of takotsubo syndrome (TTS) [27,28]. We have described such a case of TTS in the course of MIS-C before [29].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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“…Recent reviews on the manifestations of cardiac involvement in patients with MIS‐C revealed a high rate of coronary artery dilatation or aneurysms ranging from 14% to 48% 40–42 . While no specific risk factors or demographic features for early identification of those at risk were previously reported, a recent report by Ludwikowska et al 43 . stated that younger children are more likely to develop coronary artery abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study

Tseng,

Lin,

Huang

et al. 2023

Int J of Rheum Dis

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BackgroundMultisystem inflammatory syndrome in children (MIS‐C) is a rare and serious systemic inflammatory disorder that occurs following a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. This study aims to investigate the clinical manifestations, risk factors associated with pediatric intensive care unit (PICU) admission, and outcome among children with MIS‐C in Taiwan.MethodsA retrospective analysis was conducted among pediatric patients diagnosed with MIS‐C between June 2022 and February 2023 at Chang Gung Memorial Hospital, Linkou, Taiwan. Data on demographics, clinical features, laboratory findings, treatment modalities, and outcomes were collected and analyzed.ResultsTwenty‐eight MIS‐C patients, including 9 boys and 19 girls, with an average age of 5.3 ± 3.8 years old, were enrolled. Most of the cases (78.6%) were diagnosed following the first pandemic wave of COVID‐19 in Taiwan. The leading clinical manifestations observed were fever (100%), skin rash (64.3%), tachycardia (46.4%), and vomiting (46.4%). Nine patients (32.1%) were admitted to the PICU due to hypotension or neurological manifestations. Higher levels of band‐form white blood cells, procalcitonin, ferritin, d‐dimer, prothrombin time, NT‐proBNP, and lower platelet levels on arrival were associated with PICU admission (p = 3.9 × 10−2,9 × 10−3, 4 × 10−3,1 × 10−3, 5 × 10−3, 4.1 × 10−2, and 3.4 × 10−2, respectively). Arrhythmia in one case (3.5%) and coronary artery abnormalities, including dilatation in two cases (7.1%) and small aneurysms in one case (3.5%) were identified. Regardless of ICU admission, no patients experienced systolic dysfunction or mortality following treatment.ConclusionMIS‐C cases in Taiwan have a favorable outcome. Although one‐third of the patients required PICU admission, none of the MIS‐C cases resulted in severe cardiovascular morbidity or mortality. This study provides valuable insights into the clinical manifestations and outcomes associated with PICU admission in children with MIS‐C in Taiwan.

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“…In MIS-C, cardiac involvement is frequent, as it has been estimated that approximately up to 80% of affected children develop manifestations from the cardiovascular system [11][12][13]. These manifestations include ventricular dysfunction, valvular dysfunction, pericardial effusion, arrhythmias, conduction disorders, Coronary Artery Abnormalities (CAA) and in severe cases acute heart failure and cardiogenic shock [5,11,[14][15][16]. From the above, the most common cardiac finding in MIS-C, is Left Ventricular (LV) systolic myocardial dysfunction, which may range from subclinical myocardial injury to severe dysfunction [5,11,13,16,17].…”

Section: Introductionmentioning

confidence: 99%

“…From the above, the most common cardiac finding in MIS-C, is Left Ventricular (LV) systolic myocardial dysfunction, which may range from subclinical myocardial injury to severe dysfunction [5,11,13,16,17]. Within days to weeks from the acute illness, the cardiac manifestations, that are described in this syndrome, usually resolve and conventional echocardiographic parameters like the LV Ejection Fraction (LVEF) return to normal, especially after the administration of effective treatment [14,18,19]. Nevertheless, it has been reported that despite preserved LVEF, cardiac strain abnormalities can be present in some patients, suggesting subclinical myocardial damage [4,14,19].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

Anagnostopoulou,

Dourdouna,

Loukopoulou

et al. 2024

Pediatr Cardiol

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Multisystem inflammatory syndrome in children (MIS-C), is a rare but severe, hyperinflammatory complication of COVID-19, in which cardiovascular abnormalities are frequently detected. In this prospective study, we describe the echocardiographic findings in patients with MIS-C, with the use of conventional Echocardiography and Speckle-Tracking Echocardiography (STE) with Left Ventricular (LV) Global Longitudinal Strain (GLS) analysis, in the acute and follow-up phase. In total, 25 MIS-C patients [64% females, mean (± SD) age: 8.3 (± 3.72) years] were included. In the acute phase, median (IQR) Troponin and NT-proBNP and mean heart rate, were 8.07 (14.52) pg/mL, 2875.00 (7713.00) pg/mL, and 102.87 (± 22.96) bpm, respectively. Median (IQR) LV Ejection Fraction (LVEF) was 66 (8)% and LVEF impairment was detected in 2/25 (8%) patients. On follow-up (mean time interval:9.50 ± 4.59 months), heart rate was significantly lower, with a mean value of 90.00 (± 14.56) bpm (p-value = 0.017). Median (IQR) LVEF was 66.00 (6.70)% (p-value = 0.345) and all 25 participants had normal LVEF. In 14/25 patients, additional LV-GLS analysis was performed. During the acute phase, mean LV-GLS was − 18.02 (± 4.40)%. LV-GLS was abnormal in 6/14 patients (42.9%) and among them, only one patient had reduced LVEF. On follow-up (median (IQR) time interval:6.93 (3.66) months), mean LV-GLS was -20.31 (± 1.91)% (p-value = 0.07) and in 1/14 patient (7.1%), the LV-GLS impairment persisted. In conclusion, in the acute and follow-up phase, we detected abnormal LV-GLS values in some patients, in the presence of normal LVEF, indicating that STE-GLS is a valuable tool for identifying subclinical myocardial injury in MIS-C.

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Takotsubo syndrome as a cardiac manifestation of multisystem inflammatory syndrome in children

Cited by 5 publications

References 9 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

Clinical manifestations and outcomes associated with PICU admission in children with multisystem inflammatory syndrome in Taiwan: A retrospective cohort study

Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

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