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Molecular Mechanisms and Pathophysiology of Myocardial Disease: Insights from Pediatric Inflammatory Multisystem

María Teresa Viadero1,2, María Jesús Caldeiro2, Natalia Fernández-Suarez1,2

  • 1Pediatric Cardiology, Division of Pediatrics, University Hospital "Marqués de Valdecilla", University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain.

International Journal of Molecular Sciences
|May 7, 2025
PubMed

Insights

Multisystem inflammatory syndrome in children (MIS-C) can cause heart problems. Elevated ferritin and neutrophil-to-lymphocyte ratio (NLR) may indicate ventricular dysfunction in MIS-C patients.

Area of Science:

  • Pediatric Cardiology
  • Immunology
  • Molecular Pathophysiology

Background:

  • Multisystem inflammatory syndrome in children (MIS-C), or pediatric inflammatory multisystem syndrome (PIMS), poses challenges in pediatric cardiology.
  • Its complex molecular pathophysiology requires further investigation, particularly concerning myocardial involvement.

Purpose of the Study:

  • To investigate molecular contributors to myocardial dysfunction in MIS-C.
  • To identify potential prognostic indicators for ventricular dysfunction in pediatric patients.

Main Methods:

  • Retrospective analysis of 15 MIS-C cases managed at a tertiary care center.
  • Evaluation of cytokine storms, hyperinflammation markers, and hypercoagulable states.
  • Analysis of ferritin, NT-ProBNP, troponin, and neutrophil-to-lymphocyte ratio (NLR) in relation to ventricular dysfunction.

Main Results:

  • Transient myocardial involvement occurred in 46.6% of patients, with full recovery.
  • Elevated ferritin, NT-ProBNP, and troponin levels correlated with ventricular dysfunction.
  • Higher NLR was observed in patients with ventricular dysfunction, suggesting prognostic value.
  • No coronary artery aneurysms were detected.

Conclusions:

  • Early, standardized interventions are crucial for mitigating severe outcomes in MIS-C.
  • NLR and ferritin show promise as early indicators for identifying high-risk MIS-C patients with potential cardiac involvement.
  • Understanding molecular mechanisms aids in managing MIS-C-related myocardial dysfunction.

Keywords:
IVIGKawasaki diseaseSARS-CoV-2biomarkerscorticosteroidscytokine stormendothelial dysfunctionmultisystem inflammatory syndrome in children (MIS-C)myocardial dysfunctionpediatric inflammatory multisystem syndrome (PIMS)

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