Lilia Oreto, Fabio Toscano, Francesco Letterio De Luca, Letteria Bruno, Giuseppe Mandraffino, Gianluca Di Bella, Pasquale Crea, Agata Vitale, Malgorzata Wasniewska, Eloisa Gitto, Immacolata Rulli, Giovanni Conti, Roberto Chimenz, Simone Foti Randazzese, Annalisa Alaimo, Fabrizia Centineo, Paolo Guccione, Daniela Poli
MIS-C with cardiovascular involvement has a substantial incidence of acute myocardial dysfunction, particularly in patients with higher levels of TroponinT and BNP and in those who developed MAS. Cardiovascular abnormalities are usually transient. However, in 10% of cases, mild abnormalities are still detected by cardiovascular imaging in the long-term, without any correlation with the severity of the acute phase.
BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a relatively rare complication of COVID-19, with frequent cardiovascular involvement, in terms of pericarditis, valvulitis, coronary aneurysms, and myocardial dysfunction/cardiogenic shock. Prognosis appears to be benign, but data about long-term follow-up are limited.
AIMS AND OBJECTIVES: We aimed at describing acute cardiovascular complications and evaluating residual abnormalities in the mid-term (1-6 months) and long-term (>7 months) follow-up in children with MIS-C and cardiovascular involvement.
MATERIALS AND METHODS: We retrospectively reviewed data of all patients aged <16 years with MIS-C and cardiovascular involvement (2021-2023). Evaluation at admission included electrocardiogram (ECG), echocardiography, cardiac magnetic resonance (CMR), TroponinT, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and signs of macrophage activation syndrome (MAS). Follow-up was based on ECG, echocardiography and, when appropriate, CMR.
RESULTS: Twenty-nine consecutive patients (20 males, mean age 7.16 ± 5.12 years) with MIS-C showed cardiovascular involvement. Pericarditis was the most frequent feature (72. 4%), followed by valvulitis (51.7%), myocardial dysfunction (34.5%), and coronary artery dilatation (10.3%). Receiver operating characteristic curves identified TroponinT >105.05 and NT-proBNP >5817.5 as potential predictors of myocardial dysfunction. MAS was associated to 12-fold higher risk of myocardial dysfunction (P = 0.036). In the long-term, mild abnormalities were still documented in up to 10.3% of cases.
CONCLUSIONS: MIS-C with cardiovascular involvement has a substantial incidence of acute myocardial dysfunction, particularly in patients with higher levels of TroponinT and BNP and in those who developed MAS. Cardiovascular abnormalities are usually transient. However, in 10% of cases, mild abnormalities are still detected by cardiovascular imaging in the long-term, without any correlation with the severity of the acute phase.