Cardiovascular Follow-up of Patients Treated for MIS-C
Dayna Zimmerman1,2, Mark Shwayder1,2,3, Andrew Souza1,2,3
1Division of Cardiology.
Insights
Multisystem inflammatory disease in children (MIS-C) can cause lasting heart issues. Follow-up cardiac tests reveal frequent abnormalities, even without initial signs of heart injury, indicating a need for cardiology care.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Imaging
- Critical Care Medicine
Background:
- Multisystem inflammatory disease in children (MIS-C) is a serious condition that can affect multiple organs, including the heart.
- Understanding the long-term cardiovascular consequences of MIS-C is crucial for effective patient management and recovery.
- Residual cardiovascular pathology may persist months after acute illness, necessitating comprehensive assessment.
Purpose of the Study:
- To determine the prevalence of persistent cardiovascular abnormalities approximately six months after MIS-C.
- To evaluate the utility of cardiac MRI (CMR), ambulatory rhythm monitoring, and cardiopulmonary exercise testing (CPET) in detecting these abnormalities.
- To compare findings between patients with and without evidence of myocardial injury during the acute phase of MIS-C.
Main Methods:
- Patients diagnosed with MIS-C were prospectively enrolled for follow-up assessments.
- Cardiac MRI (CMR), ambulatory rhythm monitoring, and cardiopulmonary exercise testing (CPET) were performed around six months post-illness.
- Myocardial injury during acute illness was defined by elevated Troponin-I or reduced left ventricular function on echocardiogram.
Main Results:
- Of 153 patients with MIS-C, 69 underwent at least one cardiac follow-up study.
- Among patients with documented myocardial injury during acute illness, significant abnormalities were found on CMR (46%), rhythm monitoring (12%), and CPET (82%).
- Notably, patients without apparent acute myocardial injury also showed high rates of abnormalities on CMR (52%) and CPET (73%), with no statistically significant differences between groups.
Conclusions:
- A substantial proportion of children treated for MIS-C exhibit cardiovascular abnormalities on follow-up testing.
- The presence of abnormal findings was consistent regardless of whether myocardial injury was apparent during the acute illness.
- These findings underscore the importance of routine cardiology follow-up for all MIS-C patients to monitor for and manage potential long-term cardiac sequelae.
Objectives:
To assess the prevalence of residual cardiovascular pathology by cardiac MRI (CMR), ambulatory rhythm monitoring, and cardiopulmonary exercise testing (CPET) in patients ∼6 months after multisystem inflammatory disease in children (MIS-C).
Methods:
Patients seen for MIS-C follow-up were referred for CMR, ambulatory rhythm monitoring, and CPET ∼6 months after illness. Patients were included if they had ≥1 follow-up study performed by the time of data collection. MIS-C was diagnosed on the basis of the Centers for Disease Control and Prevention criteria. Myocardial injury during acute illness was defined as serum Troponin-I level >0.05 ng/mL or diminished left ventricular systolic function on echocardiogram.
Results:
Sixty-nine of 153 patients seen for MIS-C follow-up had ≥1 follow-up cardiac study between October 2020-June 2022. Thirty-seven (54%) had evidence of myocardial injury during acute illness. Of these, 12 of 26 (46%) had ≥1 abnormality on CMR, 4 of 33 (12%) had abnormal ambulatory rhythm monitor results, and 18 of 22 (82%) had reduced functional capacity on CPET. Of the 37 patients without apparent myocardial injury, 11 of 21 (52%) had ≥1 abnormality on CMR, 1 of 24 (4%) had an abnormal ambulatory rhythm monitor result, and 11 of 15 (73%) had reduced functional capacity on CPET. The prevalence of abnormal findings was not statistically significantly different between groups.
Conclusions:
The high prevalence of abnormal findings on follow-up cardiac studies and lack of significant difference between patients with and without apparent myocardial injury during hospitalization suggests that all patients treated for MIS-C warrant cardiology follow-up.
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