Long-term CMR Findings in Pediatric COVID-19 Related Myocarditis

Q: What are the key findings of this study?

In pediatric patients with COVID-19-related myocarditis, late gadolinium enhancement declined from 46% on early CMR to 0% on long-term CMR, and pericardial effusions similarly declined from 46% to 0%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: COVID-19-related myocarditis (n=21). Intervention: COVID-19-related myocarditis. Primary outcome: Evolution of CMR findings (LGE, EGE, pericardial effusion) over time.

Q: What does this research mean for the field?

In pediatric patients with COVID-19-related myocarditis, most cardiac magnetic resonance abnormalities resolve over time, with late gadolinium enhancement and pericardial effusions decreasing from 46% at early follow-up to 0% at long-term follow-up. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ana L. Vasquez Choy; Dilachew A. Adebo; Mehul D. Patel; Santosh C. Uppu; Rami Kharouf; Li Xiong

doi:10.1007/s00246-026-04331-y

June 18, 2026Pediatric CardiologyOpen Access

Long-term CMR Findings in Pediatric COVID-19 Related Myocarditis

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Key result

Long-term CMR shows LGE and pericardial effusions decline to 0% in pediatric COVID-19 myocarditis.

n=21

Why the study?

While acute CMR findings in COVID-19-related myocarditis and MIS-C are often favorable, the persistence of abnormalities over time remains uncertain.

What are the long-term CMR findings in pediatric patients with COVID-19-related myocarditis?

Key Points

To assess the persistence and temporal trajectory of cardiac magnetic resonance abnormalities in pediatric patients diagnosed with COVID-19- and MIS-C-related myocarditis.
Conducted a retrospective cohort study of N=21 pediatric patients (mean age 13.1 years, 57% male) evaluated between March 2020 and July 2023 with suspected COVID-19-associated myocarditis (MIS-C: 57%, suspected COVID-19: 24%, confirmed COVID-19: 19%).
Analyzed 30 total CMR examinations stratified by interval—early (< 30 days), mid-term (30–364 days), and long-term (≥ 365 days)—using the 2009 Lake Louise criteria, with 8 patients undergoing follow-up CMR at a median of 347 days.
Across temporal scans, late gadolinium enhancement (LGE) decreased from 46% in early to 25% in mid-term and 0% in long-term studies, and pericardial effusions decreased from 46% to 25% to 0%, while early gadolinium enhancement (EGE) remained present in 77%, 83%, and 80%, respectively.
Baseline LGE exhibited significant lateral wall predominance (Cochran's Q = 13.38, p = 0.004), occurring in 8 of 8 patients (100%) who had LGE compared to less frequent septal (38%), anterior (25%), and inferior (13%) involvement.
Among 8 patients with serial CMR, none had edema on follow-up, LGE persisted in 1 of 8 (13%), pericardial effusion in 1 of 8 (13%), and only 1 of 8 (13%) continued to meet Lake Louise criteria, with no arrhythmias, heart failure symptoms, or deaths over a median clinical follow-up of 20 months (IQR 11–38).

Study Design

Type

Cohort (n=21)

Multicenter

No

Structured PICO

What are the long-term CMR findings in pediatric patients with COVID-19-related myocarditis?

P

Population

21 pediatric patients (mean age 13.1 years, 43% female) with suspected COVID-19-related myocarditis or MIS-C, followed for a median of 20 months.

E

Exposure

Cardiac magnetic resonance (CMR) imaging at early (< 30 days), mid (30-364 days), and long-term (≥ 365 days) intervals.

O

Outcome

CMR imaging abnormalities (LGE, EGE, pericardial effusion, Lake Louise criteria) over timesurrogate

In pediatric COVID-19-related myocarditis, most CMR abnormalities such as LGE and pericardial effusion resolve over time, though early gadolinium enhancement (EGE) frequently persists despite favorable clinical outcomes.

Limitations

Retrospective, single-center design limits generalizability and introduces potential for incomplete data capture.
Small sample size with only a subset of patients undergoing follow-up CMR, increasing the risk of selection bias.
Timing of initial CMR varied, with some first clinically indicated examinations performed beyond 30 days from diagnosis.
Use of the 2009 Lake Louise criteria instead of the revised 2018 criteria, which may offer improved sensitivity.
Clinical follow-up data were limited to a median of 20 months and relied on electronic health records without standardized rhythm monitoring.
Small sample size
Retrospective design

Implication

Supports reassuring CMR trajectory in pediatric COVID myocarditis; leaves open clinical relevance of persistent EGE.

Abstract

Cardiac magnetic resonance (CMR) is a key modality for diagnosing and monitoring myocarditis, including cases related to COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C). While acute findings are often favorable, the persistence of abnormalities over time remains uncertain. This retrospective study included 21 pediatric patients with suspected COVID-19-related myocarditis between March 2020 and July 2023. All underwent CMR as part of clinical evaluation. Imaging findings were analyzed at early (< 30 days), mid (30-364 days), and long-term (≥ 365 days) intervals. Myocarditis was defined using the 2009 Lake Louise criteria. Of the 21 patients (mean age 13.1 years, 57% male), 8 had follow-up CMRs (median time to follow-up 347 days). Etiologies included MIS-C (57%), confirmed COVID-19 (19%), and suspected COVID-19 (24%). A total of 30 CMR studies were analyzed. Initial CMR met 2009 Lake Louise criteria in 8 patients (38%). Across temporally categorized studies, LGE declined from 46% of early studies to 25% of mid-term studies and was absent on long-term studies; pericardial effusions similarly declined from 46% to 25% to 0%. EGE remained frequent across timepoints (77%, 83%, and 80%, respectively). Among patients with serial CMR, no patient had edema on follow-up, LGE persisted in 1 of 8 (13%), pericardial effusion in 1 of 8 (13%), and only 1 of 8 (13%) continued to meet Lake Louise criteria. Biventricular systolic function remained normal on follow-up imaging. Initial LGE demonstrated marked lateral wall predominance (Cochran's Q = 13.38, p = 0.004). Median clinical follow-up was 20 months (IQR 11-38), with no documented arrhythmias, heart failure symptoms, cardiac-related rehospitalizations, or mortality. In pediatric myocarditis associated with COVID-19, most CMR abnormalities improve over time, with resolution of edema and substantial reduction in LGE and pericardial effusion. Persistent EGE remains common, although its clinical significance is uncertain. Medium-term clinical outcomes were favorable. Larger prospective studies are needed to define the long-term significance of persistent imaging abnormalities.

Discussion

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Cite This Study

Choy et al. (2026) conducted a cohort in COVID-19-related myocarditis (n=21). COVID-19-related myocarditis was evaluated on Evolution of CMR findings (LGE, EGE, pericardial effusion) over time. In pediatric patients with COVID-19-related myocarditis, late gadolinium enhancement declined from 46% on early CMR to 0% on long-term CMR, and pericardial effusions similarly declined from 46% to 0%.

synapsesocial.com/papers/6a359850dd3be7785e70ed8b https://doi.org/10.1007/s00246-026-04331-y

Topics

Myocarditis

COVID-19 cardiovascular

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Long-term CMR Findings in Pediatric COVID-19 Related Myocarditis

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Long-term CMR Findings in Pediatric COVID-19 Related Myocarditis

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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