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Cardiac Magnetic Resonance Follow-Up of Children After Pediatric Inflammatory Multisystem Syndrome Temporally
Marta Bartoszek1, Łukasz A Małek2, Marzena Barczuk-Falęcka1
1Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland.
Insights
Pediatric inflammatory multisystem syndrome (PIMS-TS) in children typically shows no lasting heart damage on cardiac MRI three months after hospitalization. This suggests PIMS-TS cardiac involvement is a temporary inflammatory response, not persistent viral injury.
Area of Science:
- Pediatric cardiology
- Cardiovascular imaging
- Infectious disease complications
Background:
- Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) can cause cardiac issues in children.
- The long-term cardiac effects of PIMS-TS are not well understood.
- Cardiac involvement is common in PIMS-TS, but persistent changes require further investigation.
Purpose of the Study:
- To assess the frequency and nature of myocardial complications in children with PIMS-TS and initial cardiac involvement.
- To evaluate cardiac changes using cardiac magnetic resonance imaging (MRI) three months post-hospitalization.
- To analyze persistent myocardial changes after PIMS-TS using advanced MRI techniques.
Main Methods:
- Retrospective analysis of 19 children diagnosed with PIMS-TS and initial cardiac involvement.
- Cardiac MRI including cine imaging, T1 mapping, T2 mapping, and late gadolinium enhancement (LGE) performed at 3 months post-hospitalization.
- Analysis of cardiac MRI parameters by experienced observers, compared to pediatric normal values.
Main Results:
- No persistent cardiac changes were observed on MRI 3 months after hospitalization in children with PIMS-TS.
- All patients exhibited normal left ventricular size, function, and pre-contrast T1/T2 relaxation times.
- Mild pericardial effusion was noted in 16% of patients, but no signs of LGE were present.
Conclusions:
- Cardiac involvement in PIMS-TS appears to be a transient inflammatory process.
- No evidence of persistent myocardial injury or significant cardiac sequelae was found on follow-up MRI.
- Findings support the hypothesis that PIMS-TS cardiac manifestations are reversible.
Background:
Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is an inflammatory disease occurring in a small minority of children a few weeks after acute infection. Cardiac manifestations are common, but little is known about the potentially persistent heart changes after PIMS-TS.
Purpose:
To analyze the frequency and type of myocardial complications of PIMS-TS with initial cardiac involvement assessed with cardiac magnetic resonance imaging (MRI), including parametric imaging, performed 3 months after hospitalization.
Study Type:
Retrospective.
Population:
Nineteen consecutive children (median age 10 years, interquartile range (IQR) 10-15 years, 74% male).
Field Strength/Sequence:
Balanced steady state free precession (bSSFP, cine imaging), modified Look-Locker (T1 mapping), T2-prepared bSSFP (T2-mapping), dark-blood T2-weighted turbo spin echo with fat suppression and phase sensitive inversion recovery (late gadolinium enhancement (LGE)) sequences at 1.5 T.
Assessment:
Patients were scanned after a median of 99 days (IQR 89-104 days) from the diagnosis. MR data were reviewed by three independent observers, with 13, 2, and 5 years' experience in cardiac MRI. Pre- and post-contrast T1, T2, extra-cellular volume, and T2 signal intensity (T2 SI) ratio were calculated. Diagnosis of acute myocarditis was based on modified Lake Louise criteria. Cardiac MRI parameters were compared, where possible, to previously published pediatric normal values.
Statistical Tests:
Interclass correlation coefficient and Bland-Altman repeatability analysis. A P-value <0.05 was considered statistically significant.
Results:
Despite cardiac involvement including decreased left ventricular ejection fraction (LVEF) (median LVEF = 47%, IQR 43%-53%) and increased troponin I (median 101 ng/mL, IQR 50-661 ng/mL) during hospitalization, there were no persistent cardiac changes observed in cardiac MR at follow-up. All patients had normal size and function of the left ventricle and normal precontrast T1 and T2 relaxation times. There were no signs of LGE. Persistent, mild pericardial effusion (8-9 mm) was found in three (16%) patients.
Data Conclusion:
There were no persistent changes on cardiac MRI in a group of children approximately 3 months post hospitalization due to PIMS-TS with cardiac involvement. This supports the hypothesis that cardiac involvement during PIMS-TS is a form of transient inflammatory response rather than direct and potentially persistent injury from the virus.
Level Of Evidence:
4 TECHNICAL EFFICACY: Stage 3.
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