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Coronary artery dilation in children with MIS-C: prevalence, risk factor, and progression
Phung Nguyen The Nguyen1,2, Tran Thanh Thuc3,4, Nguyen Thanh Hung2,5
1University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Insights
Coronary artery dilation in children with multisystem inflammatory syndrome (MIS-C) often resolves within three months. Male sex, Kawasaki-like symptoms, and mesenteric lymphadenitis are key risk factors for this cardiac complication in MIS-C patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Public Health
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition following SARS-CoV-2 infection.
- Cardiac complications, especially coronary artery dilation, are a major concern in MIS-C.
- Understanding risk factors and recovery is crucial for managing MIS-C patients.
Purpose of the Study:
- To determine the prevalence of coronary artery abnormalities in Vietnamese children with MIS-C.
- To identify risk factors associated with coronary artery dilation in MIS-C.
- To assess the progression and recovery of coronary artery abnormalities over a 3-month follow-up period.
Main Methods:
- A prospective multicenter case series study was conducted in Vietnam.
- 195 MIS-C patients were diagnosed using WHO criteria and followed for 3 months post-discharge.
- Data on demographics, clinical features, lab findings, and treatments were collected and analyzed.
Main Results:
- 33.3% of MIS-C patients presented with coronary artery abnormalities upon admission.
- Independent risk factors for coronary artery dilation included male sex, Kawasaki-like phenotype, and mesenteric lymphadenitis.
- Only 3.6% of patients had persistent coronary artery abnormalities after 3 months, indicating a favorable recovery.
Conclusions:
- Coronary artery dilation in MIS-C patients demonstrates a positive recovery trend within three months.
- Male sex, Kawasaki-like MIS-C, and mesenteric lymphadenitis are significant independent risk factors for developing coronary artery dilation.
- Early identification of these risk factors can aid in timely intervention and management of MIS-C cardiac complications.
Abstract:
Cardiac injury is the critical issue in children with MIS-C, particularly coronary artery dilation. This study aimed to describe the prevalence, risk factors associated with coronary artery abnormalities, and their progression after 3 months of follow-up in MIS-C children in Vietnam. A prospective multicenter case series study was conducted on MIS-C patients diagnosed per WHO criteria from September 2021 to February 2023 at the two largest pediatric hospitals in southern Vietnam. Data on demographics, clinical features, laboratory findings, and treatments during the acute phase of MIS-C were collected. Patients were followed for 3 months post-discharge and categorized into normal and abnormal coronary artery groups for comparative analysis. Among 195 patients (mean age 6.3 years; male to female ratio 1.5:1), 33.3% exhibited coronary artery abnormalities at admission. Treatment included a combination of intravenous immunoglobulin (IVIG) and corticosteroids (53.3%), corticosteroids alone (42.6%), and IVIG alone (4.1%). After 3 months, only 3.6% of patients had persistent coronary artery abnormalities. Independent risk factors for coronary artery dilation included male sex (OR 4.59; 95% CI 1.62-12.94; p = 0.004), Kawasaki-like phenotype (OR 6.42; 95% CI 2.25-18.33; p = 0.001), and mesenteric lymphadenitis (OR 8.79; 95% CI 1.74-44.31; p = 0.008).
Conclusion:
Coronary artery dilation in MIS-C patients shows a favorable recovery trajectory after a 3-month follow-up. Male sex, Kawasaki-like MIS-C, and mesenteric lymphadenitis are independent risk factors for coronary artery dilation in MIS-C patients.
What Is Known:
• Multisystem inflammatory syndrome in children (MIS-C) is a severe inflammatory syndrome following SARS-CoV-2 infection, often leading to cardiac complications, particularly coronary artery dilation.
What Is New:
• Coronary artery dilation in MIS-C patients mostly resolves within three months of follow-up. Factors associated with coronary artery dilation in MIS-C patients include: male sex, Kawasaki-like phenotype and mesenteric lymphadenitis.
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