Pediatric and Congenital Cardiology Unit, Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy.
Institute of Radiology, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy.
Eur Heart J Cardiovasc Imaging. 2022 Jul 21;23(8):1066-1074. doi: 10.1093/ehjci/jeac096.
Multisystem inflammatory syndrome in children (MIS-C) with cardiovascular manifestations are frequent. However, there is lacking evidence regarding cardiological follow-up of this cohort of patients. The aim of our study was to describe the early and mid-term cardiac abnormalities assessed by standard and speckle-tracking echocardiography (STE), and cardiac MRI (CMR).
We enrolled 32 patients (21 male, 11 female), mean age 8.25 ± 4years, with diagnosis of MIS-C. During admission, all children underwent TTE, STE with analysis of left ventricle global longitudinal strain (GLS) and CMR. Patients underwent cardiological evaluation at 2 (T1) and 6 months (T2) after discharge. Cardiac MRI was repeated at 6 months after discharge. Mean left ventricular ejection fraction (LVEF) at baseline was 58.8 ± 10% with 10 patients (31%) below 55%. Speckle-tracking echocardiography showed reduced mean LV GLS (-17.4 ± 4%). On CMR, late gadolinium enhancement (LGE) with non-ischaemic pattern was evident in 8 of 23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 ± 7.5 vs. 58.8 ± 10.6%, P-value 0.044) with only three patients (10%) below ≤ 55% at T1. Left ventricular (LV) GLS remained impaired at T1 (-17.2 ± 2.7 vs.-17.4 ± 4, P-value 0.71) and significantly improved at T2 (-19 ± 2.6% vs. -17.4 ± 4%, P-value 0.009). LV GLS was impaired (>-18%) in 53% of patients at baseline and T1, whereas only 13% showed persistent LV GLS reduction at T2. Follow-up CMR showed LGE persistence in 33.4% of cases.
Early cardiac involvement significantly improves during follow-up of MIS-C patients. However, subclinical myocardial dysfunction seems to be still detectable after 6 months of follow-up in a not negligible proportion of them.
儿童多系统炎症综合征（MIS-C）常伴有心血管表现。然而，目前缺乏关于该患者群体心脏随访的证据。本研究的目的是描述通过标准和斑点追踪超声心动图（STE）以及心脏磁共振成像（CMR）评估的早期和中期心脏异常。
我们纳入了 32 名（21 名男性，11 名女性）平均年龄为 8.25±4 岁的 MIS-C 患儿。在住院期间，所有患儿均接受 TTE、STE 检查，以分析左心室整体纵向应变（GLS）和 CMR。患儿在出院后 2 个月（T1）和 6 个月（T2）进行心脏评估。出院后 6 个月时重复心脏 MRI。基线时左心室射血分数（LVEF）平均为 58.8±10%，其中 10 名患儿（31%）低于 55%。STE 显示平均 LV GLS 降低（-17.4±4%）。在 23 名患者中，8 名（35%）有非缺血模式的延迟钆增强（LGE）。随访数据显示，T1 时 LVEF 迅速改善（62.5±7.5%比 58.8±10.6%，P 值=0.044），仅有 3 名患儿（10%）仍低于≤55%。T1 时 LV GLS 仍受损（-17.2±2.7%比-17.4±4%，P 值=0.71），T2 时明显改善（-19±2.6%比-17.4±4%，P 值=0.009）。基线和 T1 时，53%的患者存在 GLS 受损（>-18%），而 T2 时仅有 13%的患者持续存在 LV GLS 降低。随访 CMR 显示，33.4%的病例仍存在 LGE 持续存在。
MIS-C 患者的早期心脏受累在随访期间显著改善。然而，在相当一部分患者中，亚临床心肌功能障碍在随访 6 个月后仍可检测到。
