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CMR Findings in the Long-Term Outcomes After Multisystem Inflammatory Syndrome in Children (MUSIC) Study
Sean M Lang1, Dongngan T Truong2, Andrew J Powell3
1Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.M.L., M.D.T.).
Insights
Multisystem Inflammatory Syndrome in Children (MIS-C) patients showed low rates of cardiac dysfunction and myocardial abnormalities on medium-term follow-up using cardiac MRI. A small number experienced mild residual issues, highlighting the need for continued monitoring.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Pediatric Infectious Diseases
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) often involves acute cardiac complications.
- Long-term effects of MIS-C on cardiac function are not well understood.
- Cardiac magnetic resonance (CMR) can assess myocardial health in MIS-C.
Purpose of the Study:
- To characterize systolic function and myocardial tissue properties in MIS-C patients.
- To evaluate medium-term cardiac sequelae in a large cohort of MIS-C patients.
- To utilize CMR imaging for detailed cardiac assessment post-MIS-C.
Main Methods:
- Analysis of 263 CMR studies from 255 MIS-C patients across 32 North American centers.
- Assessment of ventricular volumes, tissue characterization, and coronary arteries by a core laboratory.
- Longitudinal evaluation at 3 months, 6 months, and 1 year post-hospitalization.
Main Results:
- Left ventricular dysfunction was mild and infrequent (6.7% initially, decreasing over time).
- Late gadolinium enhancement (myocardial scarring) was rare (0.8%).
- Coronary artery dilation occurred in 7.5% of patients; 3.5% met criteria for myocarditis.
Conclusions:
- Medium-term follow-up reveals a low prevalence of significant cardiac dysfunction and myocardial abnormalities in MIS-C patients.
- Mild residual cardiac abnormalities can persist in a small subset of patients up to 1 year post-hospitalization.
- CMR is valuable for assessing cardiac recovery and identifying potential long-term sequelae in MIS-C survivors.
Background:
Multisystem Inflammatory Syndrome in Children is characterized by high rates of acute cardiovascular involvement with rapid recovery of organ dysfunction. However, information regarding long-term sequelae is lacking. We sought to characterize the systolic function and myocardial tissue properties using cardiac magnetic resonance (CMR) imaging in a multicenter observational cohort of patients with Multisystem Inflammatory Syndrome in Children.
Methods:
In this observational cohort study, comprising 32 centers in North America, CMR studies were analyzed by a core laboratory to assess ventricular volumetric data, tissue characterization, and coronary involvement.
Results:
A total of 263 CMRs from 255 patients with Multisystem Inflammatory Syndrome in Children were analyzed. The mean patient age was 11.4±4.4 years. Most studies were performed at 3 months (33%) or 6 months (45%) after hospitalization. Left ventricular dysfunction was present in 17 (6.7%) of the first CMRs and was never worse than mild. Dysfunction was observed in 4/7 (57%) patients at admission, 5/87 (6.9%) patients at 3 months, and 6/129 (4.6%) patients imaged either at 6 months or 1 year post-hospitalization. Late gadolinium enhancement was present in 2 (0.8%) patients, 1 at 3 months and another at 6 months following hospitalization. Coronary artery dilation was present in 13 of the 174 (7.5%) patients. Nine patients met the Lake Louise criteria for myocarditis (3.5%) at the time of CMR.
Conclusions:
In this largest published multiinstitutional longitudinal CMR evaluation of confirmed patients with Multisystem Inflammatory Syndrome in Children, the prevalence of ventricular dysfunction and myocardial tissue characterization abnormalities on medium-term follow-up was low. However, a small number of patients had mild residual abnormalities at 6 months and 1 year following hospitalization.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT05287412.
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