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

Kamila M Ludwikowska1, Nafeesa Moksud2, Paweł Tracewski3

  • 1Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland.

Biomedicines
|May 27, 2023
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) involving the heart often improves quickly, though some children experience contractility issues or coronary artery abnormalities. Echocardiography helps track cardiovascular involvement and recovery in MIS-C patients.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Immunology

Background:

  • Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 infection.
  • Cardiovascular involvement is common in MIS-C, with acute heart failure and cardiogenic shock being the most severe outcomes.
  • Echocardiography is crucial for assessing cardiac function in affected children.

Purpose of the Study:

  • To characterize the cardiovascular manifestations and clinical course of MIS-C using echocardiography.
  • To identify factors associated with cardiac dysfunction in pediatric MIS-C patients.
  • To evaluate the recovery patterns of cardiac abnormalities in MIS-C.

Main Methods:

  • Retrospective analysis of echocardiographic data from 498 hospitalized children with MIS-C across 50 Polish cities.
  • Assessment of cardiovascular involvement including valvular insufficiency, contractility abnormalities, and left ventricular ejection fraction (LVEF).
  • Comparison of clinical and laboratory findings between children with and without cardiac abnormalities, and analysis of changes over time.

Main Results:

  • Over 91% of MIS-C patients exhibited cardiovascular involvement, including valvular insufficiency (48.2%), contractility abnormalities (41.0%), and decreased LVEF (35.6%).
  • Most cardiac abnormalities showed improvement within days, with significant LVEF increases observed even in children with initially normal LVEF.
  • Older children with contractility dysfunction had lower lymphocytes, platelets, and sodium, and higher inflammatory markers; younger children were more prone to coronary artery abnormalities (CAA).

Conclusions:

  • The majority of children with acute heart failure due to MIS-C demonstrate significant improvement within days.
  • While coronary artery abnormalities were infrequent, impaired contractility and other cardiac issues were prevalent and distinct features in MIS-C patients.
  • Further studies are warranted to confirm these findings due to the exploratory nature of this research.

Keywords:
CAACOVID-19Kawasaki diseaseLVEFPIMS-TSacute heart failurechildrencoronary artery aneurysmejection fractionpaediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2takotsubo syndrome

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