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Cardiac effects of multisystem inflammatory syndrome in children: One-year follow-up
Özlem Özgür Gündeşlioğlu1, Berivan Subaşı2, Ferhat Pişkin3
1Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) frequently impacts the heart, but cardiac function often improves with treatment. Long-term monitoring revealed potential fibrosis and arrhythmias in some MIS-C patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Pediatric Critical Care
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition with frequent cardiovascular complications.
- Early and long-term cardiac effects of MIS-C require thorough investigation to guide management and improve outcomes.
Purpose of the Study:
- To evaluate the early and long-term cardiac effects in children diagnosed with MIS-C.
- To assess the recovery of cardiac function and identify potential persistent cardiac abnormalities following MIS-C.
Main Methods:
- Observational cohort study of 26 children treated for MIS-C between October 2020 and November 2021.
- Serial echocardiography during hospitalization and at 1, 3, 6, and 12 months post-discharge.
- Holter monitoring (4-6 months) and cardiac MRI (6+ months) for comprehensive cardiac assessment.
Main Results:
- 73.1% of patients exhibited cardiac involvement, with initial mean ejection fraction of 56.7%.
- Coronary artery dilatation occurred in 7.7%, with mitral regurgitation resolving in most by 3 months.
- Cardiac MRI revealed possible interstitial fibrosis in 7.7% of patients; 2 patients developed ventricular arrhythmias.
Conclusions:
- Cardiac involvement in MIS-C generally improves rapidly with treatment.
- Persistent findings like ventricular arrhythmias and possible interstitial fibrosis warrant continued surveillance, particularly with cardiac MRI.
- Cardiac MRI is valuable for evaluating critically ill pediatric patients and those with low ejection fraction post-MIS-C.
Aim:
Cardiovascular involvement is common among children with multisystem inflammatory syndrome (MIS-C) and can cause shock and death. In this study, we evaluated the early and long-term cardiac effects of MIS-C.
Methods:
In this observational cohort study, we included all children treated for MIS-C from October 2020 to November 2021 in the Department of Paediatric Infectious Disease at Cukurova University School of Medicine Hospital. The patients underwent serial echocardiographical evaluation during hospitalisation and at 1, 3, 6 and 12 months after discharge. The patients were evaluated using Holter monitorisation between 4 and 6 months and using cardiac magnetic resonance imaging at 6 months and thereafter.
Results:
Twenty-six patients diagnosed with MIS-C and with a median age of 84 months were included. Cardiac involvement was found in 19 (73.1%) patients. At initial echocardiographic evaluation, the mean ejection fraction value of the patients was 56.7% (range: 30-75). Coronary artery dilatation was detected in two (7.7%) patients, and mitral regurgitation persisted in only one patient by month 3. Treatment was started in two (7.7%) patients due to ventricular arrhythmia. Cardiac magnetic resonance imaging was performed in 13 (50%) patients at a median of 6 months (range: 5-9). The cardiac magnetic resonance imaging findings were consistent with possible interstitial fibrosis in two (7.7%) patients.
Conclusion:
Our results showed that cardiac involvement of patients improved rapidly with treatment, as indicated by previous studies. However, during the 1-year follow-up, frequent extraventricular systole was detected in two patients, one of whom initially did not show cardiac involvement. Moreover, possible interstitial fibrosis was detected in the cardiac magnetic resonance imaging (MRI) evaluation of two patients. In particular, we believe that these findings may be useful to evaluate critically ill paediatric patients and patients with severely low EF with cardiac MRI in their follow-up.
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