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Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study
Niya Mileva1, Georgi H Vasilev2,3, Borislav Ganev4
1Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria.
Insights
Multisystem inflammatory syndrome in children (MIS-C) frequently involves the heart, with over half of cases showing cardiovascular signs like pericarditis. Elevated inflammatory markers and clustering analysis highlight significant cardiac involvement in MIS-C patients, necessitating cardiological screening.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a significant post-infectious complication.
- Cardiac involvement is a common and serious manifestation of MIS-C.
- Understanding cardiovascular involvement patterns is crucial for effective management.
Purpose of the Study:
- To summarize the types and severity of cardiovascular involvement in children with MIS-C.
- To identify associations between laboratory, inflammatory, and imaging findings and clinical phenotypes.
- To utilize cluster analysis to define MIS-C patient groups based on cardiovascular involvement.
Main Methods:
- Retrospective observational single-center study of 51 children meeting MIS-C criteria.
- Analysis of cardiovascular signs including hypotension, heart failure, pericardial effusion, and myocarditis.
- Hierarchical clustering analysis to group patients based on clinical and laboratory data.
Main Results:
- 53% of MIS-C patients exhibited at least one cardiovascular sign.
- Acute pericarditis was observed in 73% of assessed children, with effusion in 46.7%.
- Elevated CRP and IL-6 levels were associated with pericarditis and pericardial effusion. Cluster analysis revealed two groups: one without cardiovascular symptoms and another with significant cardiac involvement and elevated inflammatory markers (fibrinogen, IL-6).
Conclusions:
- Children with MIS-C frequently present with cardiovascular complications.
- Elevated inflammatory markers like IL-6 and fibrinogen are linked to severe cardiovascular involvement.
- Screening for cardiological issues is recommended for children with oligosymptomatic MIS-C or suspected long COVID-19.
Abstract:
Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.
