Özgür Gündeşlioğlu Özlem, Subaşı Berivan, Pişkin Ferhat, Atmış Anıl, Demir Fadli, Erdem Sevcan, Alabaz Derya, Çay Ümmühan, Tapaç Nisanur, Kılınç Fatma, Kaymaz Selime T, Özgür Horoz Özden, Yıldızdaş Rıza D, Ünal İlker
Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey.
Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey.
J Paediatr Child Health. 2023 Apr;59(4):637-643. doi: 10.1111/jpc.16363. Epub 2023 Feb 14.
Cardiovascular involvement is common among children with multisystem inflammatory syndrome (MIS-C) and can cause shock and death. In this study, we evaluated the early and long-term cardiac effects of MIS-C.
In this observational cohort study, we included all children treated for MIS-C from October 2020 to November 2021 in the Department of Paediatric Infectious Disease at Cukurova University School of Medicine Hospital. The patients underwent serial echocardiographical evaluation during hospitalisation and at 1, 3, 6 and 12 months after discharge. The patients were evaluated using Holter monitorisation between 4 and 6 months and using cardiac magnetic resonance imaging at 6 months and thereafter.
Twenty-six patients diagnosed with MIS-C and with a median age of 84 months were included. Cardiac involvement was found in 19 (73.1%) patients. At initial echocardiographic evaluation, the mean ejection fraction value of the patients was 56.7% (range: 30-75). Coronary artery dilatation was detected in two (7.7%) patients, and mitral regurgitation persisted in only one patient by month 3. Treatment was started in two (7.7%) patients due to ventricular arrhythmia. Cardiac magnetic resonance imaging was performed in 13 (50%) patients at a median of 6 months (range: 5-9). The cardiac magnetic resonance imaging findings were consistent with possible interstitial fibrosis in two (7.7%) patients.
Our results showed that cardiac involvement of patients improved rapidly with treatment, as indicated by previous studies. However, during the 1-year follow-up, frequent extraventricular systole was detected in two patients, one of whom initially did not show cardiac involvement. Moreover, possible interstitial fibrosis was detected in the cardiac magnetic resonance imaging (MRI) evaluation of two patients. In particular, we believe that these findings may be useful to evaluate critically ill paediatric patients and patients with severely low EF with cardiac MRI in their follow-up.
多系统炎症综合征（MIS-C）患儿中心血管受累情况常见，可导致休克和死亡。在本研究中，我们评估了MIS-C对心脏的早期和长期影响。
在这项观察性队列研究中，我们纳入了2020年10月至2021年11月在库库洛瓦大学医学院医院儿科传染病科接受MIS-C治疗的所有儿童。患者在住院期间以及出院后1、3、6和12个月接受系列超声心动图评估。在4至6个月期间使用动态心电图监测对患者进行评估，并在6个月及之后使用心脏磁共振成像进行评估。
纳入了26例诊断为MIS-C且中位年龄为84个月的患者。19例（73.1%）患者存在心脏受累。在初次超声心动图评估时，患者的平均射血分数值为56.7%（范围：30 - 75）。2例（7.7%）患者检测到冠状动脉扩张，到第3个月时仅1例患者持续存在二尖瓣反流。2例（7.7%）患者因室性心律失常开始治疗。13例（50%）患者在中位时间6个月（范围：5 - 9）时接受了心脏磁共振成像检查。心脏磁共振成像结果显示2例（7.7%）患者可能存在间质纤维化。
我们的结果表明，如先前研究所示，患者的心脏受累情况经治疗后迅速改善。然而，在1年的随访中，2例患者检测到频繁的室性早搏，其中1例最初未表现出心脏受累。此外，在2例患者的心脏磁共振成像（MRI）评估中检测到可能的间质纤维化。特别是，我们认为这些发现可能有助于在随访中对危重症儿科患者和射血分数严重降低的患者进行心脏MRI评估。
