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Multicenter Study
. 2023 Feb;182(2):845-854.
doi: 10.1007/s00431-022-04748-6. Epub 2022 Dec 9.

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

Simone Benvenuto  1 , Gabriele Simonini  2 , Sara Della Paolera  3 , Sarah Abu Rumeileh  4 , Maria Vincenza Mastrolia  2 , Alessandra Manerba  5 , Daniela Chicco  3 , Manuel Belgrano  6 , Thomas Caiffa  3 , Marco Cattalini  7 , Andrea Taddio  8   3
Affiliations
Multicenter Study

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

Simone Benvenuto et al. Eur J Pediatr. 2023 Feb.

Abstract

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.

Keywords: COVID-19; Cardiac MRI; MIS-C; Myocarditis; Outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CMR imaging in a patient with previous MIS-C, showing subepicardial/intramyocardial LGE in the basal inferolateral wall of the left ventricle (red arrows). CMR, cardiac magnetic resonance; MIS-C, multisystem inflammatory syndrome in children; LGE, late gadolinium enhancement
See this image and copyright information in PMC

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