Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents
Vladislav Vukomanovic1,2, Stasa Krasic1, Sergej Prijic1,2
1Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia.
Insights
Early recognition and treatment of myocardial injury in children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19 led to full recovery. Cardiac function improved rapidly following therapy, with no long-term complications observed.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 can cause myocardial damage.
- Cardiac involvement, including elevated cardiac biomarkers and left ventricular dysfunction, is a serious concern in pediatric MIS-C cases.
Purpose of the Study:
- To evaluate the cardiac outcomes in children with MIS-C and myocardial injury.
- To assess the effectiveness of early recognition and treatment on cardiac recovery in pediatric MIS-C.
Main Methods:
- Retrospective observational cohort study of pediatric patients with COVID-19-related myocardial injury.
- Inclusion criteria: children under 18 with elevated cardiac troponin/NT-proBNP, LV dysfunction, arrhythmias, or coronary artery abnormalities.
- Cardiac assessments included ECG, labs, echocardiography, Holter monitoring, stress tests, and cardiac MRI.
Main Results:
- Six male adolescents with MIS-C and myocardial injury were analyzed.
- Elevated cardiac biomarkers (troponin, NT-proBNP) and LV systolic dysfunction (EF 45.2 ± 6.9%) were observed.
- Rapid improvement in cardiac function (P < 0.001) and inflammatory markers occurred after IVIG and inotropic support, with no development of dilated cardiomyopathy or coronary aneurysms.
Conclusions:
- Early diagnosis and appropriate therapy for MIS-C are crucial for complete cardiac recovery in children.
- Children with MIS-C-related myocardial injury can achieve full recovery with prompt management.
- Short-term follow-up confirmed sustained cardiac health without significant long-term sequelae.
Background:
In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported.
Materials And Methods:
A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed.
Results:
Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms.
Conclusions:
With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period.
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