Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) is a known severe condition affecting children previously exposed to SARS-CoV-2. The aim of our study was to describe the early cardiac abnormalities in patients with MIS-C, evaluated by speckle tracking echocardiography (STE) and cardiac MRI (CMR). Clinical, laboratory and microbiological data were measured for all patients. All children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS). Seventeen (75%) of the children were evaluated with CMR. Twenty-three patients (13M, 10F) were recruited, mean age was 8.1 ± 4 years. Cardiovascular symptoms were present in 10 (43.5%). Nine children (39.1%) shared Kawasaki Disease-like symptoms. Four patients (17.4%) needed ICU admission. In-hospital survival was 100%. TnI was elevated in 15 (65.2%) and BNP in 20 (86.9%) patients. The median time to STE evaluation was 8 days and to CMR was 18 days after fever onset. Mean LVEF was 59 ± 10%. Coronary dilation was observed in six (26.1%) patients. STE showed a reduced mean LVGLS (−17 ± 4.3%). LGE with a non-ischemic pattern was evident in six out of seventeen patients (35.2%). The elevation of myocardial necrosis markers, the reduction of LVGLS and the presence of LGE on CMR in about a quarter of MIS-C patients supports the hypothesis of a post-viral immune-mediated myocarditis-like pathogenesis.
Highlights
Since the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has represented the greatest health care concern worldwide
Initial reports showed less severe COVID-19 acute manifestations among children compared to adults [1,2,3,4], growing evidence has been produced regarding a severe systemic hyperinflammation syndrome, named Multisystem Inflammatory Syndrome in Children (MIS-C), affecting children and adolescents exposed to SARS-CoV2 from 2 to 6 weeks earlier [5]
The characteristic features of the disease are fever, gastrointestinal symptoms, muco-cutaneous inflammation signs and myocardial and coronary artery involvement. This multisystemic illness shares features with other pediatric inflammatory conditions, such as Kawasaki disease (KD), bacterial sepsis, toxic shock syndrome and macrophage activation syndrome [6]
Summary
Since the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has represented the greatest health care concern worldwide. The characteristic features of the disease are fever, gastrointestinal symptoms, muco-cutaneous inflammation signs and myocardial and coronary artery involvement. This multisystemic illness shares features with other pediatric inflammatory conditions, such as Kawasaki disease (KD), bacterial sepsis, toxic shock syndrome and macrophage activation syndrome [6]. Cardiovascular manifestations in MIS-C are common, occurring in 34–82% of cases [8]. They include myocardial dysfunction, coronary artery dilation or aneurysms, arrhythmia, conduction abnormalities, pericarditis and valvulitis.
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