Cardiac MRI in midterm follow-up of MISC: a multicenter study

• Published in: European journal of pediatrics Vol. 182; no. 2; pp. 845 - 854
• Main Authors: Benvenuto, Simone, Simonini, Gabriele, Della Paolera, Sara, Abu Rumeileh, Sarah, Mastrolia, Maria Vincenza, Manerba, Alessandra, Chicco, Daniela, Belgrano, Manuel, Caiffa, Thomas, Cattalini, Marco, Taddio, Andrea
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2023; Springer Nature B.V
• Subjects: Child; Contrast Media; Echocardiography; Edema; Effusion; Follow-Up Studies; Gadolinium; Heart; Humans; Hypotension; Inflammation; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Medicine; Medicine & Public Health; Multisystem inflammatory syndrome in children; Patients; Pediatrics; Retrospective Studies; Stroke Volume; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Function, Left - physiology; COVID-19; Myocarditis; MIS-C; Cardiac MRI; Outcome
• ISSN: 1432-1076; 0340-6199; 1432-1076
• DOI: 10.1007/s00431-022-04748-6

In this multicenter retrospective study we aimed to evaluate the outcome of cardiac involvement in children affected by multisystem inflammatory syndrome (MIS-C), assessed through cardiac magnetic resonance (CMR). Children referring to three Italian tertiary pediatric centers between February 2020 and November 2021 with a diagnosis of MIS-C, who underwent CMR during a follow-up visit, were enrolled. Demographic, clinical, laboratory, treatment, and outcome data were collected. Twenty MIS-C patients (aged 9–17, median 12 years) were included in the study. Heart involvement at onset was testified by hypotension/shock (55%), laboratory evidence of myocardial involvement (100%), reduced LV ejection fraction (EF) on echocardiography (83%), and/or need for inotrope agents (40%); they all presented good clinical, laboratory, and echocardiographic response to treatment. CMR was performed after a median interval of 3 months from discharge. Pericardial effusion and myocardial edema were found in 5% of patients. Mild residual left ventricular (LV) dysfunction was found in 20% of patients, all showing normal echocardiographic LVEF at discharge. Minimal myocardial scars were found in 25% by late gadolinium enhancement (LGE). One patient was evaluated at two consecutive time points, showing partial resolution of a myocardial scar after 7 months from its first finding. Conclusion : Despite the severity of heart involvement in the acute MIS-C phase, the mid-term cardiac outcome is good. Direct cardiac tissue viral invasion may be involved in MIS-C pathogenesis. What is Known: • Heart involvement is common in MIS-C, but conflicting findings have been shown regarding cardiac outcome when assessed through cardiac MRI. What is New: • Midterm cardiac MRI shows mild abnormalities in patients recovered from MIS-C with any grade of severity of cardiac involvement at presentation.