Three-Dimensional Echocardiography and Global Longitudinal Strain in Follow-Up After Multisystem Inflammatory
Halszka Kamińska1, Anna Rożnowska-Wójtowicz1, Andrzej Cacko2
1Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland.
Insights
Multisystem inflammatory syndrome in children (MIS-C) shows normal cardiac function by 6 weeks. Left ventricular function improves by 6 months, indicating an optimistic long-term prognosis for children with MIS-C.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Research
Background:
- Multisystem inflammatory syndrome in children (MIS-C) can present with significant cardiovascular involvement.
- Assessing the long-term cardiac sequelae of MIS-C is crucial for understanding disease prognosis.
Purpose of the Study:
- To evaluate the potential long-term cardiac effects in children following MIS-C, particularly in those with acute cardiovascular involvement.
- To track ventricular function over time using advanced echocardiographic techniques.
Main Methods:
- Prospective study of 172 children diagnosed with MIS-C.
- Utilized 3-dimensional echocardiography and global longitudinal strain (GLS) to assess left ventricular (LV) and right ventricular (RV) function.
- Follow-up assessments at 6 weeks, 3 months (for severe cases), and 6 months post-MIS-C.
Main Results:
- Cardiac function, including ejection fraction (EF) and GLS, was within normal limits at 6 weeks post-MIS-C, irrespective of initial severity.
- A statistically significant improvement in LV function was observed between 6 weeks and 6 months.
- While RV function remained stable, severe cardiac involvement cases showed a delayed LV recovery pattern between 3 and 6 months.
Conclusions:
- Cardiac function in children with MIS-C is generally normal by 6 weeks post-illness.
- Left ventricular function demonstrates continued improvement up to 6 months, suggesting a favorable long-term cardiac outlook.
- The study indicates a positive prognosis with full recovery of cardiac function following MIS-C.
Objective:
To assess the potential long-term cardiac effects after multisystem inflammatory syndrome in children (MIS-C) with cardiovascular involvement in the acute phase.
Study Design:
Our prospective study involved children consecutively diagnosed with MIS-C between October 2020 and February 2022 and followed 6 weeks and 6 months after the disease. In patients with severe cardiac involvement during the acute phase, an additional check-up after 3 months was scheduled. In all patients at all check-ups, 3-dimensional echocardiography and global longitudinal strain (GLS) were used to assess ventricular function.
Results:
The study enrolled 172 children aged 1-17 years (median, 8 years). The means of ejection fraction (EF) and GLS for both ventricles were within normal limits after 6 weeks with no relationship with initial severity: left ventricular EF (LVEF) 60% (59%-63%), LV GLS -21.08% (-18.63% to -23.2%), right ventricular (RV) EF 64% (62%-67%), and RV GLS -22.8% (-20.5% to -24.5%). Further, statistically significant improvement of LV function was observed after 6 months-LVEF 63% (62%-65%) and LV GLS -22.55% (-21.05% to -24.25%; P < .05); however, RV function remained unchanged. The group with severe cardiac involvement showed LV function recovery pattern with no significant improvement between 6 weeks and 3 months after MIS-C, while still improving between 3 and 6 months after discharge.
Conclusions:
LV and RV function is within normal limits 6 weeks after MIS-C regardless of severity of cardiovascular involvement; LV function improves further between 6 weeks and 6 months after the disease. The long-term prognosis is optimistic with full recovery of cardiac function.
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