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Comparison of Cardiac Findings in Pediatric Patients with Multisystem Inflammatory Syndrome in Children Associated
Seval Ozen1, Harun Terin2, Pinar Bayraktar1
1Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can cause cardiac dysfunction and coronary artery abnormalities (CAAs). Older children with MIS-C and cardiac issues had higher inflammatory markers and lower albumin levels.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious hyperinflammatory condition post-COVID-19.
- Cardiovascular abnormalities, including cardiac dysfunction and coronary artery abnormalities (CAAs), are common in MIS-C.
- Predicting which children develop cardiac involvement in MIS-C is crucial for management.
Purpose of the Study:
- To investigate demographic, echocardiographic, laboratory, and outcome differences in MIS-C patients based on cardiac involvement.
- To identify factors associated with myocardial dysfunction and CAAs in MIS-C.
- To compare MIS-C patient characteristics across four groups defined by cardiac involvement.
Main Methods:
- Retrospective analysis of 135 MIS-C patients diagnosed between July 2020 and August 2022.
- Patients categorized into four groups based on myocardial dysfunction and/or CAAs.
- Analysis of demographic data, echocardiographic findings, laboratory results, and COVID-19 variants.
Main Results:
- 38% of MIS-C patients had decreased left ventricular ejection fraction (LVEF), and 44% had CAAs.
- Patients admitted to the pediatric intensive care unit (PICU) were older and had cardiac dysfunction.
- Higher CRP and lower albumin levels were observed in older patients with cardiac dysfunction in the PICU.
Conclusions:
- Cardiac dysfunction and CAAs are significant concerns in MIS-C patients.
- Older age, elevated CRP, and low albumin are associated with cardiac involvement in MIS-C.
- Early identification and monitoring of cardiac function are essential for managing MIS-C.
Objectives:
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication of COVID-19 in which cardiovascular abnormalities are frequently detected. In the context of MIS-C, it remains uncertain which patients will develop cardiac dysfunction and which will experience coronary artery abnormalities (CAAs). To investigate this, patients were categorized into four distinct groups based on the presence or absence of myocardial dysfunction and/or CAAs. We aimed to determine whether there were any differences in demographic, echocardiographic, laboratory results, outcome, and COVID-19 variants between the groups.
Methods:
Between July 2020 and August 2022, 135 MIS-C diagnosed patients were divided into 4 groups according to their cardiovascular involvement.
Results:
The mean age of the patients was 104 months (9-209 months) and the male/female ratio was 1.45. Thirty-eight percent of the patients had decreased LVEF and 44% had signs of CAAs. Fifty-nine percent (80/135) of the patients were admitted to the pediatric intensive care unit (PICU). Patients admitted to the PICU were older patients with cardiac dysfunction. The severity of cardiac involvement ranged from severe to mild in Group 1, Group 2, Group 3, and Group 4, respectively. Group 1 was older (median age 146 months, p=0.008), albumin was lower (p=0.015) and CRP was higher than Group 4 (p=0.007). PICU admission/stay time and CRP elevation were significant in the groups with decreased LVEF (groups 1 and 2). More MIS-C patients were observed in the alpha wave compared to other waves, but there was no difference in the severity of cardiac involvement (p=0.25). Cardiac dysfunction and improvement in CAAs were observed in patients. The case fatality rate was 1.48%.
Conclusion:
D-dimer, CRP, ferritin levels were higher, lymphocyte, platelet and albumin levels were lower in elderly patients with cardiac dysfunction who were followed up in the PICU.
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