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Heart Involvement in Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children: The Retrospective

Mikhail M Kostik1, Liudmila V Bregel2,3, Ilia S Avrusin1

  • 1Hospital Pediatry Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.

Frontiers in Pediatrics
|March 21, 2022
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) can affect the heart. This study identified specific criteria, including elevated troponin or combined face swelling and D-dimer levels, to help diagnose myocardial involvement in MIS-C patients.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Heart involvement is a significant concern in children diagnosed with multisystem inflammatory syndrome associated with COVID-19 (MIS-C).
  • Accurate and timely diagnosis of cardiac complications in MIS-C is crucial for effective management and treatment.
  • This study aims to characterize the spectrum of cardiac manifestations in MIS-C patients.

Purpose of the Study:

  • To describe the various forms of heart involvement observed in pediatric patients with MIS-C.
  • To identify clinical and laboratory features associated with different types of cardiac involvement, specifically coronary artery lesions (CAL) and myocardial involvement (MI).
  • To propose diagnostic criteria for identifying myocardial involvement in MIS-C.

Main Methods:

  • A retrospective, multicenter cohort study included 122 pediatric patients meeting WHO and CDC criteria for MIS-C.
  • Data analysis focused on categorizing heart involvement into solely CAL, solely MI, or a combination of both.
  • Clinical signs, laboratory values (e.g., troponin, D-dimer, ferritin, LDH), and outcomes (e.g., shock, ICU admission) were compared across patient groups.

Main Results:

  • Patients with solely CAL (8.2%) resembled Kawasaki disease, while those with solely MI (24.6%) presented with older age, elevated ferritin/LDH/D-dimer, and thrombocytopenia.
  • Clinical signs associated with MI included gastrointestinal/CNS disorders, sore throat, facial swelling, splenomegaly, shock, and ICU need.
  • A proposed diagnostic approach using one major criterion (troponin > 32 pg/ml) or two minor criteria (face swelling and D-dimer > 1,300 ng/ml) showed 67.5% sensitivity and 88.9% specificity for MI.

Conclusions:

  • Distinct clinical and laboratory profiles differentiate coronary artery lesions from myocardial involvement in MIS-C.
  • Specific criteria, including elevated troponin and combinations of D-dimer and facial swelling, can aid in diagnosing myocardial involvement.
  • These criteria can be integrated into routine diagnostic protocols for MIS-C patients with suspected cardiac issues.
Abstract

Keywords:
childrencoronary artery lesionscytokine storm syndromehypercytokine syndromemultisystem inflammatory syndromemyocarditisshocktroponin

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