Subtle Cardiac Troubles in MIS-C Paint a 'Myocarditis-Like P
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Multisystem inflammatory syndrome in children (MIS-C) caused by SARS-CoV-2 infection was often accompanied by subtle changes in myocardial function that differ from what is seen in classic Kawasaki disease, one center reported.

Researchers retrospectively reviewed 28 MIS-C, 20 healthy controls and 20 classic Kawasaki disease (KD) patients. They reviewed echocardiographic parameters in acute phase of MIS-C and KD groups, and during subacute period in MIS-C group.

-- Only 1 case in MIS-C manifested coronary artery dilatation in acute phase, showing resolution during early follow up.
-- Left ventricular (LV) systolic and diastolic function measured by deformation parameters, were worse in MIS-C compared to KD.
-- Moreover, MIS-C patients with myocardial injury (+) were more affected than myocardial injury (-) MIS-C with respect to all functional parameters.
-- The strongest parameters to predict myocardial injury in MIS-C were global longitudinal strain (GLS), global circumferential strain (GCS), peak left atrial strain (LAS) and peak longitudinal strain of right ventricular free wall (RVFWLS).
-- The preserved LVEF group in MIS-C showed diastolic dysfunction.
-- During subacute period, LVEF returned to normal but diastolic dysfunction persisted.

Conclusively, 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.