Hostname: page-component-84b7d79bbc-l82ql Total loading time: 0 Render date: 2024-07-28T04:04:47.973Z Has data issue: false hasContentIssue false
  • English
  • Français

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement

Part of: Infectious

Published online by Cambridge University Press:  24 March 2022

Omeir A. Aziz ,
Masood Sadiq Open the ORCID record for Masood Sadiq [Opens in a new window] ,
Ahmad U. Qureshi ,
Najam Hyder ,
Uzma Kazmi ,
Afsheen Batool ,
Samia Naz ,
Asma Mushtaq ,
Attia Bari  and
Junaid Rashid
Omeir A. Aziz
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Masood Sadiq*
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Ahmad U. Qureshi
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Najam Hyder
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Uzma Kazmi
Affiliation:
Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Afsheen Batool
Affiliation:
Department of Paediatrics, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Samia Naz
Affiliation:
Department of Paediatrics, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Asma Mushtaq
Affiliation:
Department of Paediatrics, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Attia Bari
Affiliation:
Department of Paediatrics, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
Junaid Rashid
Affiliation:
Department of Paediatrics, The Children’s Hospital, University of Child Health Sciences, Lahore, Pakistan
*
Author for correspondence: Prof M. Sadiq, The Children’s Hospital, University of Child Health Sciences, Ferozepur Road, Lahore 54000, Pakistan. Tel: +92-429-9230614; Fax: +92-42-99230358. E-mail: drmasoodsadiq@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

We aim to describe the early and upto 16 months follow-up of post-coronavirus disease (COVID), multi-system inflammatory syndrome in children (MIS-C), with special reference to cardiac involvement.

Study design:

This cohort non-interventional descriptive study included patients <18 years admitted between May, 2020 and April, 2021. Based on underlying similarities, children were classified as post-COVID MIS-C with overlapping Kawasaki Disease, MIS-C with no overlapping Kawasaki Disease, and MIS-C with shock. Post-discharge, patients were followed at 1, 3, 6, 12, and 16 months.

Results:

Forty-one patients predominantly males (73%), at median age of 7 years (range 0.2–16 years) fulfilled the World Health Organisation criteria for MIS-C. Cardiac involvement was seen in 15 (36.5%); impaired left ventricle (LV) function in 5 (12.2%), coronary artery involvement in 10 (24.4%), pericardial effusion in 6 (14.6%) patients, and no arrhythmias. There were two hospital deaths (4.9%), both in MIS-C shock subgroup (2/10, 20%). At 1 month, there was persistent LV dysfunction in 2/5, coronary artery abnormalities in 7/10, and pericardial effusion resolved completely in all patients. By 6 months, LV function returned to normal in all but coronary abnormalities persisted in two patients. At last follow-up (median 9.8 months, interquartile range 2–16 months), in 36/38 (94.7%) patients, coronary artery dilatation was persistent in 2 (20%) patients.

Conclusions:

Children with MIS-C have a good early outcome, though MIS-C with shock can be life-threatening subgroup in a resource-constrained country setting. On midterm follow-up, there is normalisation of LV function in all and recovery of coronary abnormalities in 80% of patients.

Keywords

Multi-system inflammatory syndrome in childrenSARS-CoV-2COVID-19coronary artery aneurysms
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 3 , March 2023 , pp. 371 - 379
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Riphagen, S, Gomez, X, Gonzalez-Martinez, C, Wilkinson, N, Theocharis, P. Hyperinfammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607–1608.CrossRefGoogle ScholarPubMed
Verdoni, L, Mazza, A, Gervasoni, A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicenter of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 6736: 1–8.Google Scholar
Feldstein, LR, Tenforde, MW, Friedman, KG, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA 2021; 325: 1074–1087.CrossRefGoogle ScholarPubMed
McArdle, AJ, Vito, O, Patel, H, et al. Treatment of multisystem inflammatory syndrome in children. N Engl J Med 2021; 385: 11–22.CrossRefGoogle ScholarPubMed
Belay, ED, Abrams, J, Oster, ME, et al. Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic. JAMA Pediatr 2021; 175: 837–845.CrossRefGoogle ScholarPubMed
Sadiq, M, Aziz, OA, Kazmi, U, et al. Multisystem inflammatory syndrome associated with COVID-19 in children in Pakistan. Lancet Child Adolesc Health 2020; 4: e36–e37.CrossRefGoogle ScholarPubMed
Belhadjer, Z, Méot, M, Bajolle, F. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429–436.CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324: 259–269.CrossRefGoogle ScholarPubMed
Valverde, I, Singh, Y, Sanchez-de-Toledo, J, et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation 2021; 143: 21–32.CrossRefGoogle ScholarPubMed
Farooqi, KM, Chan, A, Weller, R, etal, J. Longitudinal outcomes for multisystem inflammatory syndrome in children. Pediatrics 2021; 148: e2021051155.CrossRefGoogle ScholarPubMed
Capone, CA, Misra, N, Ganigara, M, et al. Six month follow-up of patients with multi-system inflammatory syndrome in children. Pediatrics 2021; 148: e2021050973.CrossRefGoogle ScholarPubMed
Davies, P, du Pré, P, Lillie, J, Kanthimathinathan, HK. One-year outcomes of critical care patients Post-COVID-19 multisystem inflammatory syndrome in children. JAMA Pediatr 2021; 175: 1281–1283.CrossRefGoogle ScholarPubMed
Kobayashi, T, Ayusawa, M, Suzuki, H, et al. Revision of diagnostic guidelines for Kawasaki disease (6th revised edition). Pediatr Int 2020; 62: 1135–1138.CrossRefGoogle ScholarPubMed
Kosaraju, A, Goyal, A, Grigorova, Y, et al. Left Ventricular Ejection Fraction. StatPearls, Treasure Island (FL), 2021. Updated 2021 Jul 26. https://www.ncbi.nlm.nih.gov/books/NBK459131/ Google Scholar
Kane, GC, Karon, BL, Mahoney, DW, et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 2011; 306: 856–863.CrossRefGoogle ScholarPubMed
Colan, SD. Normal echocardiographic values for cardiovascular structures. In: Wyman, WL, Mertens, L, Cohen, MS, Geva, T (eds). Echocardiography in Pediatric and Congenital Heart Disease. Wiley, Hoboken, NJ, 2016: 883–901.CrossRefGoogle Scholar
Wu, EY, Campbell, MJ. Cardiac manifestations of multisystem inflammatory syndrome in children (MIS-C) following COVID-19. Curr Cardiol Rep 2021; 223: 168.CrossRefGoogle Scholar
Kobayashi, R, Dionne, A, Ferraro, A, et al. Detailed assessment of left ventricular function in multisystem inflammatory syndrome in children using strain analysis. CJC Open 2021; 3: 880–887.CrossRefGoogle ScholarPubMed
Dionne, A, Newburger, JW. The electrocardiogram in multisystem inflammatory syndrome in children: mind your Ps and Qs. J Pediatr 2021; 234: 10–11.CrossRefGoogle ScholarPubMed
Regan, W, OʼByrne, L, Stewart, K, et al. Electrocardiographic changes in children with multisystem inflammation associated with COVID-19: associated with coronavirus disease 2019. J Pediatr 2021; 234: 27–32.e2.CrossRefGoogle ScholarPubMed
Dionne, A, Mah, DY, Son, MBF, et al. Atrioventricular block in children with multisystem inflammatory syndrome. Pediatrics 2020; 146: e2020009704.CrossRefGoogle ScholarPubMed
Nelson, MC, Mrosak, J, Hashemi, S, et al. Delayed coronary dilation with multisystem inflammatory syndrome in children. CASE 2021. DOI 10.1016/j.case.2021.08.002, ISSN 2468-6441.Google ScholarPubMed
Mohsin, SS, Abbas, Q, Chowdhary, D, et al. Multisystem inflammatory syndrome (MIS-C) in Pakistani children: a description of the phenotypes and comparison with historical cohorts of children with Kawasaki disease and myocarditis. PLoS ONE 2021; 16: e0253625.CrossRefGoogle ScholarPubMed
Theocharis, P, Wong, J, Pushparajah, K, et al. Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19. Eur Heart J Cardiovasc Imaging 2021; 22: 896–903.CrossRefGoogle Scholar
Marshall, M, Ferguson, ID, Lewis, P, et al. Symptomatic acute myocarditis in 7 adolescents after Pfizer-BioNTech COVID-19 vaccination. Pediatrics 2021; 148: e2021052478.CrossRefGoogle ScholarPubMed