Echo Findings in Pediatric Multisystem Inflammatory Syndrome
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Centers from Europe and United States have reported an exceedingly high number of children with a severe inflammatory syndrome in the setting of coronavirus disease 2019, which has been termed multisystem inflammatory syndrome in children (MIS-C).

This study aimed to analyze echocardiographic manifestations in MIS-C.

A total of 28 MIS-C, 20 healthy control subjects and 20 classic Kawasaki disease (KD) patients were retrospectively reviewed. The study reviewed echocardiographic parameters in the acute phase of the MIS-C and KD groups, and during the subacute period in the MIS-C group.

-- Only 1 case in the MIS-C group (4%) manifested coronary artery dilatation in the acute phase, showing resolution during early follow-up. Left ventricular (LV) systolic and diastolic function measured by deformation parameters were worse in patients with MIS-C compared with KD.

-- Moreover, MIS-C patients with myocardial injury were more affected than those without myocardial injury with respect to all functional parameters.

-- The strongest parameters to predict myocardial injury in MIS-C were global longitudinal strain, global circumferential strain, peak left atrial strain, and peak longitudinal strain of right ventricular free wall.

-- The preserved LV ejection fraction (EF) group in MIS-C showed diastolic dysfunction.

-- During the subacute period, LVEF returned to normal but diastolic dysfunction persisted.

Unlike classic KD, coronary arteries may be spared in early MIS-C; however, myocardial injury is common. Even preserved EF patients showed subtle changes in myocardial deformation, suggesting subclinical myocardial injury. During an abbreviated follow-up, there was good recovery of systolic function but persistence of diastolic dysfunction and no coronary aneurysms.