ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology
Longitudinal Echocardiographic Follow-Up of a Pediatric Multisystem Inflammatory Syndrome Cohort [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2024; 52(3): 189-198 | DOI: 10.5543/tkda.2023.60940

Longitudinal Echocardiographic Follow-Up of a Pediatric Multisystem Inflammatory Syndrome Cohort

Jaikumar Govindaswamy Ramamoorthy1, Anantharaj Avinash2, Pediredla Karunakar2, Chinmay Parale2, Ramanathan Velayutham2, Suresh Kumar Sukumaran2, Sridhar Balaguru2, Narayanan Parameswaran1, Mugunthan M.3, Rahul Dhodapkar3, Debdatta Basu4, Raja Selvaraj2, Santhosh Satheesh2, Niranjan Biswal1
1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
2Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
3Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
4Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India


OBJECTIVE
Significant involvement of the cardiovascular system is known in multisystem inflammatory syndrome in children (MIS-C). This study aimed to examine the recovery of affected cardiovascular parameters over a medium-term follow-up.


METHODS
A cohort of 69 children was studied prospectively. Assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) were conducted at admission, 1.5 months, and 3 months. Coronavirus Disease 2019 (COVID-19) antibody titers were assessed at these three time points. Echocardiographic and antibody parameters (rising/decreasing) were analyzed for correlation. Outcomes were assessed using logistic regression.


RESULTS
At admission, among the 78.2% of patients who were tested, 88.9% tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A quarter of the patients had pericardial effusion, and half had valvulitis. Decreased ejection fraction, global circumferential strain (GCS), and global longitudinal strain (GLS) were seen in 54.4%, 68.6%, and 35.8% of patients, respectively. CAAs were observed in 27.78% of patients. Systolic dysfunction was significantly associated with older age. During follow-up, severe LV dysfunction normalized within 6-7 weeks, while mild to moderate dysfunction reached normalcy by two weeks. Both GCS and GLS reached normalcy within a median of two weeks. Diastolic parameters recovered by six weeks. Most small and moderate coronary aneurysms resolved, but a giant aneurysm in an infant remained large even after 15 months. Trends in antibodies and ejection fraction (EF) at three months were significantly correlated. Admission EF, GLS (at 6 weeks) and deceleration time (at 3 months) were significantly associated with intensive care unit (ICU) admission. The median segmental strain of the cohort remained low in certain segments at three months.


CONCLUSION
Smaller CAAs resolve, whereas giant CAAs persist. EF and GLS are important predictors of Pediatric Intensive Care Unit (PICU) stay. The residual impairment of median segmental strain and persistent diastolic dysfunction at three months indicate the need for long-term follow-up.

Keywords: Strain imaging, coronary artery abnormality, COVID-19, ventricular systolic function, diastolic function, MIS-C

How to cite this article
Jaikumar Govindaswamy Ramamoorthy, Anantharaj Avinash, Pediredla Karunakar, Chinmay Parale, Ramanathan Velayutham, Suresh Kumar Sukumaran, Sridhar Balaguru, Narayanan Parameswaran, Mugunthan M., Rahul Dhodapkar, Debdatta Basu, Raja Selvaraj, Santhosh Satheesh, Niranjan Biswal. Longitudinal Echocardiographic Follow-Up of a Pediatric Multisystem Inflammatory Syndrome Cohort. Turk Kardiyol Dern Ars. 2024; 52(3): 189-198

Corresponding Author: Anantharaj Avinash
Manuscript Language: English


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