Evaluation of late cardiac effects after multisystem inflammatory syndrome in children

Rik De Wolf; Mahmoud Zaqout; Kaoru Tanaka; Laura Muiño-Mosquera; Gerlant van Berlaer; Kristof Vandekerckhove; Wendy Dewals; Daniël De Wolf

doi:10.3389/fped.2023.1253608

Evaluation of late cardiac effects after multisystem inflammatory syndrome in children

Front Pediatr. 2023 Aug 24:11:1253608. doi: 10.3389/fped.2023.1253608. eCollection 2023.

Authors

Rik De Wolf¹, Mahmoud Zaqout^{2

3}, Kaoru Tanaka⁴, Laura Muiño-Mosquera⁵, Gerlant van Berlaer⁶, Kristof Vandekerckhove⁵, Wendy Dewals², Daniël De Wolf^{1

5}

Affiliations

¹ Department of Pediatric Cardiology, University Hospital Brussels, Brussels, Belgium.
² Department of Pediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium.
³ Department of Pediatric Cardiology, ZNA Queen Paola Children's Hospital, Antwerp, Belgium.
⁴ Department of Radiology, University Hospital Brussels, Brussels, Belgium.
⁵ Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
⁶ Department of Pediatric Intensive Care, University Hospital Brussels, Brussels, Belgium.

Abstract

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is associated with important cardiovascular morbidity during the acute phase. Follow-up shows a swift recovery of cardiac abnormalities in most patients. However, a small portion of patients has persistent cardiac sequelae at mid-term. The goal of our study was to assess late cardiac outcomes of MIS-C.

Methods: A prospective observational multicenter study was performed in children admitted with MIS-C and cardiac involvement between April 2020 and March 2022. A follow-up by NT-proBNP measurement, echocardiography, 24-h Holter monitoring, and cardiac MRI (CMR) was performed at least 6 months after MIS-C diagnosis.

Results: We included 36 children with a median age of 10 (8.0-11.0) years, and among them, 21 (58%) were girls. At diagnosis, all patients had an elevated NT-proBNP, and 39% had a decreased left ventricular ejection fraction (LVEF) (<55%). ECG abnormalities were present in 13 (36%) patients, but none presented with arrhythmia. Almost two-thirds of patients (58%) had echocardiographic abnormalities such as coronary artery dilation (20%), pericardial effusion (17%), and mitral valve insufficiency (14%). A decreased echocardiographic systolic left ventricular (LV) function was detected in 14 (39%) patients. A follow-up visit was done at a mean time of 12.1 (±5.8) months (range 6-28 months). The ECG normalized in all except one, and no arrhythmias were detected on 24-h Holter monitoring. None had persistent coronary artery dilation or pericardial effusion. The NT-proBNP level and echocardiographic systolic LV function normalized in all patients, except for one, who had a severely reduced EF. The LV global longitudinal strain (GLS), as a marker of subclinical myocardial dysfunction, decreased (z < -2) in 35%. CMR identified one patient with severely reduced EF and extensive myocardial fibrosis requiring heart transplantation. None of the other patients had signs of myocardial scarring on CMR.

Conclusion: Late cardiac outcomes after MIS-C, if treated according to the current guidelines, are excellent. CMR does not show any myocardial scarring in children with normal systolic LV function. However, a subgroup had a decreased GLS at follow-up, possibly as a reflection of persistent subclinical myocardial dysfunction.

Keywords: CMR; MIS-C; SARS-CoV-2; cardiac; children; outcome; pediatric.