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Perspective from Deepika Thacker, MD
Disclosures: The authors report no relevant financial disclosures.
January 19, 2022
2 min read

Recovery of cardiac function in COVID-19-related MIS-C quick; coronary outcomes good

Perspective from Deepika Thacker, MD
Disclosures: The authors report no relevant financial disclosures.
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Most pediatric patients with multisystem inflammatory syndrome also had evidence of myocardial injury, but functional recovery was quick with no adverse coronary outcomes, researchers reported.

According to data published in the Journal of the American Heart Association, cardiac markers of deformation improved quickly within the first week and showed continued improvement through follow-up of 3 to 4 months.

Source: Adobe Stock
Source: Adobe Stock

COVID-19-related MIS-C

“Multisystem inflammatory syndrome in children (MIS-C) is a newly described hyperinflammatory syndrome associated with antecedent COVID-19 exposure. Cardiovascular involvement is frequent (80% to 85% of cases), including shock, left ventricular dysfunction, coronary artery abnormalities and biochemical evidence of myocardial injury,” Daisuke Matsubara, MD, PhD, cardiologist at the Children’s Hospital of Philadelphia, and colleagues wrote. “The aim of this study is to describe cardiac outcomes during a 3-month follow-up period, to determine the short-term impact of acute myocardial injury caused by MIS-C.”

According to the CDC, MIS-C is a condition in which organ and systems such as the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs can become inflamed.

This analysis included 60 controls (mean age, 12 years; 55% boys; 62% white) and 60 patients with MIS-C (mean age, 10 years; 60% boys; 27% white), with echocardiograms and deformation parameters analyzed during the acute phase of COVID-19 infection, the subacute phase (3 days after initial echocardiography), at 1 month (median, 22 days) and at 3 to 4 months.

Return of cardiac function in MIS-C

The researchers defined myocardial injury during the acute phase as troponin I level of 0.09 ng/mL or more or brain-type natriuretic peptide more than 800 pg/mL.

According to the researchers, 70% of patients with MIS-C had evidence of myocardial injury at the time of presentation; however, most of the cardiac markers returned to normal by the subacute stage before hospital discharge. The researchers reported no deaths or unexpected cardiac events during follow-up.

All deformation parameters, including LV global longitudinal strain, peak left atrial strain, longitudinal early diastolic strain rate and right ventricular free wall strain, recovered quickly within the first week, and continued to improve and normalize among patients with MIS-C through the 3-month follow-up, according to the study.

Normalization of both global longitudinal strain and left atrial strain in patients with MIS-C occurred between 3 and 9 days, Matsubara and colleagues wrote.

Researchers reported that 7% of participants with MIS-C had small coronary aneurysms at presentation, all of which resolved.

Nine patients underwent cardiac MRI during follow-up (median 162 days), of whom one had residual edema but no fibrosis, according to the researchers.

“Recovery among these children was excellent,” Anirban Banerjee, MD, professor of clinical pediatrics at the University of Pennsylvania Perelman School of Medicine and an attending cardiologist with the Cardiac Center at the Children’s Hospital of Philadelphia, said in a press release. “These results have important implications for our health care teams managing care for children with MIS-C. Our findings may also provide guidance for a gradual return to playing sports after cardiac clearance 3 to 4 months later. Tests needed for clearance include electrocardiogram and echocardiogram. We also recommend cardiac MRI for children who have highly abnormal baseline cardiac MRI during the acute stage or show evidence of continued severe left ventricle dysfunction.”