tetano
Editor, Senior Moderator
Pediatr Cardiol
. 2022 Apr 29.
doi: 10.1007/s00246-022-02907-y. Online ahead of print.
Medium-Term Cardiac Outcomes in Young People with Multi-system Inflammatory Syndrome: The Era of COVID-19
James Wong[SUP] #[/SUP][SUP] 1 [/SUP], Paraskevi Theocharis[SUP] #[/SUP][SUP] 2 [/SUP], William Regan[SUP] 2 [/SUP], Kuberan Pushparajah[SUP] 2 3 [/SUP], Natasha Stephenson[SUP] 3 [/SUP], Emma Pascall[SUP] 2 [/SUP], Aoife Cleary[SUP] 2 [/SUP], Laura O'Byrne[SUP] 2 [/SUP], Alex Savis[SUP] 2 [/SUP], Owen Miller[SUP] 2 4 [/SUP]
Affiliations
Abstract
Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.
Keywords: Aneurysm; Carditis; Children; Covid; Multisystem inflammation; SARS-Cov2.
. 2022 Apr 29.
doi: 10.1007/s00246-022-02907-y. Online ahead of print.
Medium-Term Cardiac Outcomes in Young People with Multi-system Inflammatory Syndrome: The Era of COVID-19
James Wong[SUP] #[/SUP][SUP] 1 [/SUP], Paraskevi Theocharis[SUP] #[/SUP][SUP] 2 [/SUP], William Regan[SUP] 2 [/SUP], Kuberan Pushparajah[SUP] 2 3 [/SUP], Natasha Stephenson[SUP] 3 [/SUP], Emma Pascall[SUP] 2 [/SUP], Aoife Cleary[SUP] 2 [/SUP], Laura O'Byrne[SUP] 2 [/SUP], Alex Savis[SUP] 2 [/SUP], Owen Miller[SUP] 2 4 [/SUP]
Affiliations
- PMID: 35486129
- DOI: 10.1007/s00246-022-02907-y
Abstract
Multi-system inflammatory syndrome in children (MIS-C) causes widespread inflammation including a pancarditis in the weeks following a COVID infection. As we prepare for further coronavirus surges, understanding the medium-term cardiac impacts of this condition is important for allocating healthcare resources. A retrospective single-center study of 67 consecutive patients with MIS-C was performed evaluating echocardiographic and electrocardiographic (ECG) findings to determine the point of worst cardiac dysfunction during the admission, then at intervals of 6-8 weeks and 6-8 months. Worst cardiac function occurred 6.8 ± 2.4 days after the onset of fever with mean 3D left ventricle (LV) ejection fraction (EF) 50.5 ± 9.8%. A pancarditis was typically present: 46.3% had cardiac impairment; 31.3% had pericardial effusion; 26.8% demonstrated moderate (or worse) valvar regurgitation; and 26.8% had coronary dilatation. Cardiac function normalized in all patients by 6-8 weeks (mean 3D LV EF 61.3 ± 4.4%, p < 0.001 compared to presentation). Coronary dilatation resolved in all but one patient who initially developed large aneurysms at presentation, which persisted 6 months later. ECG changes predominantly featured T-wave changes resolving at follow-up. Adverse events included need for ECMO (n = 2), death as an ECMO-related complication (n = 1), LV thrombus formation (n = 1), and subendocardial infarction (n = 1). MIS-C causes a pancarditis. In the majority, discharge from long-term follow-up can be considered as full cardiac recovery is expected by 8 weeks. The exception includes patients with medium sized aneurysms or greater as these may persist and require on-going surveillance.
Keywords: Aneurysm; Carditis; Children; Covid; Multisystem inflammation; SARS-Cov2.