Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Multisystem Inflammatory Syndrome in Children (MIS-C) (n=51). Intervention: Multisystem Inflammatory Syndrome in Children (MIS-C). Primary outcome: Any sign of cardiovascular involvement (arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis, myocarditis, coronaritis, palpitations, ECG abnormalities).

Niya Mileva; Georgi Vasilev; Borislav Ganev; Lyubomir Chervenkov; Hristiana Batselova; Iren Tzotcheva; L Tomov; Tsvetelina Velikova; Snezhina Lazova

doi:10.3390/medicina59122175

December 14, 2023MedicinaOpen Access

Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study

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Key result

Cardiovascular involvement occurs in ~53% of children with MIS-C, with severe cases showing marked hyperinflammation.

n=51

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Why the study?

MIS-C poses healthcare challenges due to frequent heart involvement, prompting the need to summarize the type and degree of cardiovascular involvement and explore associations between laboratory, inflammatory, and imaging abnormalities and clinical phenotypes.

Study Design

Type

Observational (n=51)

Multicenter

No

Structured PICO

P

Population

51 children under 18 years of age with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2, followed for 1 to 6 months to evaluate cardiovascular involvement.

O

Outcome

Type and degree of cardiovascular involvement in children with MIS-C and associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype

More than half of children with MIS-C exhibited cardiovascular involvement, ranging from hypotension to myocarditis and pericarditis, which was significantly associated with elevated inflammatory markers like IL-6 and D-dimer.

Limitations

small number of children with full echocardiographic descriptions
some ECG and MRI data inconsistencies
lack of follow-up data for all patients
Selection bias due to the hospital being a referral center for pediatric abdominal and thoracic surgery (leading cardiovascular cases were referred elsewhere)
Missing data (omitted from statistical analyses up to 5%)
No sensitivity analyses performed
Single-center retrospective design

Implication

May support cardiac screening in MIS-C with elevated IL-6; hypothesis-generating for inflammatory phenotype stratification.

Abstract

Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30/41 of the children (73%) assessed using imaging: 14/30 (46.7%) with small pericardial effusion and 16/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 ± 13 mg/dL vs. 13.9 ± 11 mg/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 ± 53 ng/L vs. 88 ± 27 ng/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 ± 0.3 vs. 4.6 ± 0.3, p = 0.03) and IL-6 (158 ± 36 ng/mL vs. 66 ± 22 ng/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.

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Cite This Study

Mileva et al. (2023) conducted an observational in Multisystem Inflammatory Syndrome in Children (MIS-C) (n=51). Multisystem Inflammatory Syndrome in Children (MIS-C) was evaluated on Any sign of cardiovascular involvement (arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis, myocarditis, coronaritis, palpitations, ECG abnormalities). Fifty-three percent of children with MIS-C presented with at least one sign of cardiovascular involvement, and cluster analysis identified a severe subgroup with significantly elevated IL-6 and fibrinogen.

synapsesocial.com/papers/6a3ea2babc5541264908b1fa https://doi.org/10.3390/medicina59122175