Abstract
We are continuing to learn about the multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. There are many published studies regarding the acute management of MIS-C; however, there is still much to learn regarding the long-term outcomes of patients with MIS-C. In this study, we report the outcomes of patients admitted at our institution with MIS-C and the follow-up practices in Pediatric Cardiology over the last three years. We included patients who were admitted at Lucile Packard Children’s Hospital between January 1, 2020 and October 31, 2022, who met the CDC criteria for MIS-C, and were followed in the Pediatric Cardiology Outpatient Clinic at our institution. There were 25 patients who met our inclusion criteria. Eighteen patients (72%) had their initial follow-up visit within 1–2 weeks of discharge and seven patients (28%) had their initial follow-up visit within 4–6 weeks of discharge. Six patients out of the 25 (24%) had decreased left ventricular ejection fraction (LVEF < 50%) during their hospitalization. No patients had left main coronary artery aneurysm (z-score > 2.5), two patients (8%) had proximal right coronary artery aneurysm (z-score > 2.5), and one patient (4%) had left anterior descending coronary artery aneurysm (z-score > 2.5) during hospitalization. Patients who were admitted with the diagnosis of MIS-C showed normalization of left ventricular dysfunction at their initial follow-up visit as early as 2–4 weeks after discharge. In this cohort of MIS-C patients, a 4–6-week window for the first follow-up visit after discharge seems reasonable.
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Abbreviations
- MIS-C:
-
Multisystem inflammatory syndrome in children
- LVEF:
-
Left ventricular ejection fraction
- Echo:
-
Echocardiography
- CAD/CAA:
-
Coronary artery dilation/coronary artery aneurysm
- LMCA:
-
Left main coronary artery
- LAD:
-
Left anterior descending
- RCA:
-
Right coronary artery
References
CDC. Multisystem Inflammatory Syndrome (MIS) Published 2021. https://www.cdc.gov/mis/hcp/index.html
McArdle AJ, Vito O, Patel H et al (2021) Treatment of multisystem inflammatory syndrome in children. N Engl J Med 385(1):11–22. https://doi.org/10.1056/nejmoa2102968
Feldstein LR, Rose EB, Horwitz SM et al (2020) Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 383(4):334–346. https://doi.org/10.1056/nejmoa2021680
Alsaied T, Tremoulet AH, Burns JC et al (2021) Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation 143(1):78–88. https://doi.org/10.1161/CIRCULATIONAHA.120.049836
Farooqi KM, Chan A, Weller RJ et al (2021) Longitudinal outcomes for multisystem inflammatory syndrome in children. Pediatrics. https://doi.org/10.1542/peds.2021-051155
AAP. Multisystem inflammatory syndrome in children (MIS-C interim guidance. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance/
Son MB, Freidman K. COVID-19: multisystem inflammatory syndrome in children (MIS-C) management and outcome. https://www.uptodate.com/contents/covid-19-multisystem-inflammatory-syndrome-in-children-mis-c-management-and-outcome#H999319060
Kache S, Schwenk H, Mathew R, et al (2020) Multisystem inflammatory syndrome in children (MIS-C) pathway exclusion criteria: multisystem inflammatory syndrome in children (MIS-C) pathway determine patient disposition based on initial presentation and work-up
Son MBF, Gauvreau K, Kim S et al (2017) Predicting coronary artery aneurysms in Kawasaki disease at a North American center: an assessment of baseline z scores. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.005378
Chakraborty A, Philip R, Santoso M, Naik R, Merlocco A, Johnson JN (2022) Cardiovascular magnetic resonance in children with multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19: institutional protocol-based medium-term follow-up study. Pediatr Cardiol. https://doi.org/10.1007/s00246-022-02927-8
Arslan SY, Bal ZS, Bayraktaroglu S et al (2022) Cardiac assessment in children with MIS-C: late magnetic resonance imaging features. Pediatr Cardiol. https://doi.org/10.1007/s00246-022-02977-y
Garbin M, Raso I, Piersanti A et al (2022) Advanced echocardiographic analysis in medium-term follow-up of children with previous multisystem inflammatory syndrome. Children. https://doi.org/10.3390/children9060917
Aziz OA, Sadiq M, Qureshi AU et al (2022) Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement. Cardiol Young. https://doi.org/10.1017/S1047951122000828
Patnaik S, Jain MK, Ahmed S et al (2021) Short-term outcomes in children recovered from multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Rheumatol Int 41(11):1957–1962. https://doi.org/10.1007/s00296-021-04932-1
Jhaveri S, Ahluwalia N, Kaushik S et al (2021) Longitudinal echocardiographic assessment of coronary arteries and left ventricular function following multisystem inflammatory syndrome in children. J Pediatr 228:290-293.e1. https://doi.org/10.1016/j.jpeds.2020.08.002
Barris DM, Keelan J, Ahluwalia N et al (2022) Midterm outcomes and cardiac magnetic resonance imaging following multisystem inflammatory syndrome in children. J Pediatr 241:237-241.e1. https://doi.org/10.1016/j.jpeds.2021.10.009
Das N, Hill R, Trivedi M et al (2022) Longitudinal assessment of cardiac function following multisystem inflammatory syndrome in children associated with COVID-19. Pediatr Cardiol. https://doi.org/10.1007/s00246-022-02972-3
Sirico D, Basso A, Sabatino J et al (2022) Evolution of echocardiographic and cardiac magnetic resonance imaging abnormalities during follow-up in patients with multisystem inflammatory syndrome in children. Eur Heart J Cardiovasc Imaging 23(8):1066–1074. https://doi.org/10.1093/ehjci/jeac096
Capone CA, Misra N, Ganigara M et al (2021) Six month follow-up of patients with multi-system inflammatory syndrome in children. Pediatrics. https://doi.org/10.1542/peds.2021-050973
Jose JT, Selamet Tierney ES (2022) Outpatient monitoring of patients with multisystem inflammatory syndrome (MIS-C): a mini review. Front Pediatr. https://doi.org/10.3389/fped.2022.1069632
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JJ and ET: conceptualized the study and methodology. JJ: conducted chart review, collected data, drafted the initial manuscript text, and prepared figure 1 and tables 1-4. ET: reviewed the data, figures, and tables. All authors reviewed the final manuscript and approved the final version.
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Jose, J.T., Tierney, E.S.S. Outpatient Pediatric Cardiology Follow-Up of Patients with Multisystem Inflammatory Syndrome in Children (MIS-C): A Single-Institution, Medium-Term Follow-Up Study. Pediatr Cardiol 45, 401–409 (2024). https://doi.org/10.1007/s00246-023-03298-4
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DOI: https://doi.org/10.1007/s00246-023-03298-4