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Long-Term Follow-Up of Cardiac Magnetic Resonance Imaging in Multisystem İnflammatory Syndrome in Children Associated
Hafize Otcu Temur1, Dilek Hacer Çeşme2, Asim Enhos3
1Radiology, Bezmialem Vakif University, Istanbul, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) survivors showed no cardiac fibrosis 16 months post-illness. However, mild systolic dysfunction was detected by cardiac MRI, not standard echocardiography, indicating subtle long-term cardiac effects.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition linked to COVID-19.
- MIS-C is known to cause significant heart problems during the acute phase.
- Limited research exists on the long-term heart effects in children treated for MIS-C in pediatric intensive care units.
Purpose of the Study:
- To investigate the long-term cardiac outcomes in children who experienced MIS-C.
- To assess for cardiac fibrosis and other late cardiac effects using advanced imaging techniques.
Main Methods:
- Cardiac MRI and echocardiography (TTE) were used to evaluate heart function and structure.
- Patients were assessed a median of 16 months after the onset of MIS-C.
- Cardiac MRI included assessment for late gadolinium enhancement to detect fibrosis.
Main Results:
- No evidence of chronic cardiac scarring (late gadolinium enhancement) was found in any patient.
- Cardiac MRI revealed mild systolic dysfunction in 17% of patients, which was not detected by TTE.
- Standard echocardiography (TTE) showed normal heart function in all patients despite MRI findings.
Conclusions:
- The absence of cardiac fibrosis is a reassuring finding for long-term MIS-C outcomes.
- Mild systolic dysfunction may persist in MIS-C survivors, detectable only by cardiac MRI.
- These findings highlight the importance of advanced cardiac imaging for comprehensive assessment of MIS-C patients.
Abstract:
The researchers identified cases of multisystem inflammatory syndrome in children, which was linked to COVID-19 starting in 2020. Multisystem inflammatory syndrome in children is associated with significant cardiovascular morbidity in the acute phase. A small number of articles in the literature have recorded the long-term myocardial effects of multisystem inflammatory syndrome in children treated in pediatric intensive care units. Our study aimed to investigate the late cardiac outcomes of multisystem inflammatory syndrome in children using cardiac magnetic resonance imaging.A median of 16 months had passed after the onset of the disease in multisystem inflammatory syndrome in children. Ejection fraction (%), cardiac output (L/min), stroke volume (mL), end-diastolic volume index (mL/m2), cardiac index (L/min/m2), and stroke volume index (mL/m2) were all significantly lower in multisystem inflammatory syndrome in children. During at least a 1-year follow-up, minor cardiac damage was discovered in 26% of individuals who underwent cardiac magnetic resonance imaging. In addition, none of the 23 infants showed symptoms of late gadolinium enhancement or pericardial effusion. While all patients underwent cardiac magnetic resonance imaging, the transthoracic echocardiogram evaluation revealed normal heart function.Our study found no evidence of late gadolinium enhancement, which indicates cardiac fibrosis in cardiac magnetic resonance imaging performed after a prolonged hospitalization in multisystem inflammatory syndrome in children who were admitted to the intensive care unit. This absence of late gadolinium enhancement is a reassuring finding, suggesting that the long-term cardiac outcomes of multisystem inflammatory syndrome in children may not be as severe as initially feared. However, the long-term cardiac magnetic resonance imaging results revealed mild left ventricular dysfunction in these patients that could not be detected via a transthoracic echocardiogram.
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