Dilorenzo Michael P, Farooqi Kanwal M, Shah Amee M, Channing Alexandra, Harrington Jamie K, Connors Thomas J, Martirosyan Karen, Krishnan Usha S, Ferris Anne, Weller Rachel J, Farber Donna L, Milner Joshua D, Gorelik Mark, Rosenzweig Erika B, Anderson Brett R
CUIMC: Columbia University Irving Medical Center.
CUIMC: columbia University Irving Medical Center.
Res Sq. 2022 Jan 24:rs.3.rs-1254952. doi: 10.21203/rs.3.rs-1254952/v1.
Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe life-threatening manifestation of SARS-CoV-2 infection. Acute cardiac dysfunction and resultant cardiogenic shock are common in children with MIS-C. While most children recover rapidly from acute illness, the long-term impact on the myocardium and cardiac function is unknown. Methods In this prospective study, cardiac MRI (CMR) was performed on patients <21 years of age with a history of MIS-C, 6-9 months following hospitalization. Per institutional protocol, patients with any history of LVEF<50%, persistent cardiorespiratory symptoms, or ECG abnormalities underwent clinical CMR. Research CMRs were offered to all others >10 years old. Native T1 and T2 mapping values were compared with 20 children with normal CMR examinations. Results We performed CMRs on 13 subjects at a median age of 13.6 years (interquartile range [IQR] 11.9-16.0) and a median time from hospitalization of 8.2 months (IQR 6.8-9.6). Twelve subjects displayed normal ventricular function with a median left ventricle ejection fraction (LVEF) of 57.2% (IQR 56.1-58.4) and median right ventricular (RV) EF of 53.1% (IQR 52.0-55.7). One subject had low normal EF (52%). There was normal T2 and native T1 as compared to normal controls. There was qualitatively no evidence of edema by T2 weighted imaging. One subject had late gadolinium enhancement (LGE) at the inferior insertion point and mid-ventricular inferolateral region, with normal EF, no evidence of edema or perfusion defects, and normal T1 and T2 times. When stratifying by a history of abnormal LVEF (LVEF <55%) on echocardiography, there was no difference in or parametric mapping values, though LVEF and LVEDV approached significance (p=0.06 and 0.05, respectively). Conclusions Although many children with MIS-C present acutely with cardiac dysfunction, myocardial recovery is overall excellent with minimal to no evidence of residual cardiac dysfunction or myocardial involvement. LVEF by CMR at 6-9 months among children with history of echocardiographic LV dysfunction is slightly lower, though does not meet statistical significance and is still within normal range. The long-term functional implications of this finding and the cardiac implications of MIS-C more broadly are unclear and warrant further study.
儿童多系统炎症综合征(MIS-C)是严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的一种危及生命的表现。急性心脏功能障碍及由此导致的心源性休克在MIS-C患儿中很常见。虽然大多数患儿能迅速从急性疾病中康复,但对心肌和心脏功能的长期影响尚不清楚。方法:在这项前瞻性研究中,对年龄<21岁且有MIS-C病史的患者在住院6-9个月后进行心脏磁共振成像(CMR)检查。根据机构方案,有左心室射血分数(LVEF)<50%、持续心肺症状或心电图异常病史的患者接受临床CMR检查。研究性CMR检查提供给所有其他年龄>10岁的患者。将T1和T2 mapping值与20例CMR检查正常的儿童进行比较。结果:我们对13名受试者进行了CMR检查,中位年龄为13.6岁(四分位间距[IQR]11.9-16.0),中位住院时间为8.2个月(IQR 6.8-9.6)。12名受试者心室功能正常,左心室射血分数(LVEF)中位数为57.2%(IQR 56.1-58.4),右心室(RV)EF中位数为53.1%(IQR 52.0-55.7)。一名受试者EF略低于正常下限(52%)。与正常对照组相比,T2和T1值正常。T2加权成像在定性上没有水肿的证据。一名受试者在下心尖插入点和心室中下部外侧区域有延迟钆增强(LGE),EF正常,无水肿或灌注缺损证据及T1和T2时间正常。按超声心动图检查时LVEF异常(LVEF<55%)病史分层时,T1和T2 mapping值无差异,尽管LVEF和左心室舒张末期容积(LVEDV)接近显著差异(分别为p=0.06和0.05)。结论:虽然许多MIS-C患儿急性发病时存在心脏功能障碍,但心肌恢复总体良好,几乎没有残留心脏功能障碍或心肌受累的证据。有超声心动图显示左心室功能障碍病史的患儿在6-9个月时通过CMR检查测得的LVEF略低,虽未达到统计学意义但仍在正常范围内。这一发现的长期功能影响以及更广泛的MIS-C对心脏的影响尚不清楚,值得进一步研究。