Longitudinal Echocardiographic Follow-Up of a Pediatric Multisystem Inflammatory Syndrome Cohort
Jaikumar Govindaswamy Ramamoorthy1, Anantharaj Avinash2, Pediredla Karunakar2
1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can affect the heart, but most cardiovascular issues resolve within weeks. Persistent giant coronary artery abnormalities and some strain impairments highlight the need for long-term monitoring.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) frequently involves cardiovascular complications.
- Understanding the medium-term recovery of cardiac function and coronary arteries post-MIS-C is crucial.
Purpose of the Study:
- To assess the recovery of cardiovascular parameters in children with MIS-C during a medium-term follow-up period.
- To identify predictors of severe outcomes and intensive care unit (ICU) admission.
Main Methods:
- Prospective cohort study of 69 children with MIS-C.
- Serial echocardiographic assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) at admission, 1.5, and 3 months.
- Correlation analysis of echocardiographic parameters and COVID-19 antibody titers; logistic regression for outcome prediction.
Main Results:
- At admission, 88.9% of tested patients were positive for SARS-CoV-2; 27.78% had CAAs.
- Decreased ejection fraction, GCS, and GLS were common; most normalized within weeks to months.
- Smaller CAAs resolved, but giant aneurysms persisted; residual segmental strain impairment and diastolic dysfunction were noted at 3 months.
Conclusions:
- Cardiovascular dysfunction in MIS-C generally shows good recovery, but giant CAAs may persist.
- Ejection fraction and global longitudinal strain are key predictors of PICU stay.
- The presence of residual strain impairment and diastolic dysfunction necessitates long-term follow-up for affected children.
Objective:
Significant involvement of the cardiovascular system is known in multisystem inflammatory syndrome in children (MIS-C). This study aimed to examine the recovery of affected cardiovascular parameters over a medium-term follow-up.
Methods:
A cohort of 69 children was studied prospectively. Assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) were conducted at admission, 1.5 months, and 3 months. Coronavirus Disease 2019 (COVID-19) antibody titers were assessed at these three time points. Echocardiographic and antibody parameters (rising/decreasing) were analyzed for correlation. Outcomes were assessed using logistic regression.
Results:
At admission, among the 78.2% of patients who were tested, 88.9% tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A quarter of the patients had pericardial effusion, and half had valvulitis. Decreased ejection fraction, global circumferential strain (GCS), and global longitudinal strain (GLS) were seen in 54.4%, 68.6%, and 35.8% of patients, respectively. CAAs were observed in 27.78% of patients. Systolic dysfunction was significantly associated with older age. During follow-up, severe LV dysfunction normalized within 6-7 weeks, while mild to moderate dysfunction reached normalcy by two weeks. Both GCS and GLS reached normalcy within a median of two weeks. Diastolic parameters recovered by six weeks. Most small and moderate coronary aneurysms resolved, but a giant aneurysm in an infant remained large even after 15 months. Trends in antibodies and ejection fraction (EF) at three months were significantly correlated. Admission EF, GLS (at 6 weeks) and deceleration time (at 3 months) were significantly associated with intensive care unit (ICU) admission. The median segmental strain of the cohort remained low in certain segments at three months.
Conclusion:
Smaller CAAs resolve, whereas giant CAAs persist. EF and GLS are important predictors of Pediatric Intensive Care Unit (PICU) stay. The residual impairment of median segmental strain and persistent diastolic dysfunction at three months indicate the need for long-term follow-up.
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