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Cardiovascular involvement in multisystem inflammatory syndrome in children and midterm follow-up from a pediatric
Poovazhagi Varadarajan1, Ritchie Sharon Solomon2, Seenivasan Subramani1
1Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai 600003, Tamil Nādu, India.
Insights
Most children with multisystem inflammatory syndrome in children (MIS-C) experienced cardiovascular issues, requiring intensive care. While shock resolved rapidly, ventricular and coronary abnormalities persisted, necessitating long-term follow-up for pediatric MIS-C patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exists on cardiovascular involvement in multisystem inflammatory syndrome in children (MIS-C) from low- and middle-income countries.
- Understanding the longitudinal outcomes of cardiovascular complications in MIS-C is crucial.
Purpose of the Study:
- To investigate the pattern of cardiovascular involvement in children diagnosed with MIS-C.
- To determine the mid-term outcomes of cardiovascular complications in MIS-C.
- To identify associations between cardiovascular abnormalities and clinical/laboratory parameters.
Main Methods:
- A prospective study enrolled 270 children with MIS-C from June 2020 to January 2022.
- Echocardiography and laboratory tests were performed at admission, with follow-ups at 2 weeks, 3 months, 6 months, and 1 year.
- Multivariate regression analysis was used to identify risk factors for cardiovascular involvement and dysfunction.
Main Results:
- Cardiovascular involvement was observed in 78.2% of patients, with shock (45.6%), coronary aneurysm (28.5%), and left ventricular dysfunction (29.3%) being common.
- Breathlessness and high-flow nasal cannula support predicted cardiovascular involvement.
- Anemia was a risk factor for coronary involvement, while altered sensorium and invasive ventilation predicted shock.
Conclusions:
- A significant proportion of children with MIS-C exhibit cardiovascular involvement, leading to increased ICU admissions.
- While shock resolved quickly, ventricular function and coronary abnormalities showed slower resolution.
- Structured long-term follow-up protocols are essential for managing cardiovascular sequelae in pediatric MIS-C.
Background:
In multisystem inflammatory syndrome in children (MIS-C) with coronavirus disease 2019, there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes. We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.
Aim:
To determine association between cardiovascular abnormalities and clinical and laboratory parameters. To study the time-line for resolution of various abnormalities.
Methods:
In this prospective study done in a tertiary care hospital, 270 were recruited from June 2020 to January 2022. Baseline demographic data and clinical presentation were recorded. Laboratory parameters and echocardiography were done at admission. Follow-up was done at 2 weeks, 3 months, 6 months and 1 year after diagnosis. Descriptive statistics were used for parametric and non-parametric data. Risk factors were identified by multivariate regression analysis.
Results:
The 211 (78.2%) had cardiac involvement and 102 needed intensive care unit (ICU) admission. Cardiovascular abnormalities observed were shock 123 (45.6%), coronary dilatation 28 (10.4%), coronary aneurysm 77 (28.5%), left ventricular (LV) dysfunction 78 (29.3%), mitral regurgitation (MR) 77 (28.5%) and pericardial effusion 98 (36.3%). Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7% and 0.9% respectively. Multivariate regression analysis revealed breathlessness [odds ratio (OR) = 3.91, 95%CI: 1.25-12.21, P = 0.019] and hi-flow nasal cannula (HFNC) support (OR = 8.5, 95%CI: 1.06-68.38, P = 0.044) as predictors of cardiovascular involvement. Higher mean age (OR = 1.16, 95%CI: 1.02-1.32, P = 0.026), breathlessness (OR = 4.99, 95%CI: 2.05-12.20, P < 0.001), gallop (OR = 4.45, 95%CI: 0.41-2.52, P = 0.016), MR (OR = 3.61, 95%CI: 1.53-8.53, P = 0.004) and invasive ventilation (OR = 4.01, 95%CI: 1.28-12.58, P = 0.017) were predictive of LV dysfunction. Altered sensorium (OR = 4.96, 95%CI: 2.23-11.02, P < 0.001), headache (OR = 6.61, 95%CI: 1.46-29.92, P = 0.014), HFNC (OR = 7.03, 95%CI: 2.04-24.29, P = 0.002), non-rebreathing mask usage (OR = 21.13, 95%CI: 9.00-49.61, P < 0.001) and invasive ventilation (OR = 5.64, 95%CI: 1.42-22.45, P = 0.014) were risk factors for shock. Anemia was a risk factor for coronary involvement (OR = 3.09, 95%CI: 1.79- 5.34, P < 0.001).
Conclusion:
Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management. Although shock resolved quickly, resolution of ventricular function and coronary abnormalities were slower, and hence warrants a structured long-term follow-up protocol.
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