Ventricular function and tissue characterization by cardiac magnetic resonance imaging following hospitalization for multisystem inflammatory syndrome in children: a prospective study

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe life-threatening manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that often presents with acute cardiac dysfunction and cardiogenic shock. While recovery from acute illness is excellent, the long-term myocardial impact is unknown. Objective: To compare cardiac MRI findings in children 6–9 months after their hospitalization with MIS-C against MRI findings in healthy controls to assess for residual myocardial disease. Materials and methods: We prospectively performed cardiac MRI on 13 children 6–9 months following their hospitalization with MIS-C: eight of these children had a history of left ventricle ejection fraction (LVEF) < 50%, persistent symptoms, or electrocardiogram (ECG) abnormalities and underwent clinical MRI; five of these children without cardiac abnormalities during their hospitalization underwent research MRIs. We compared their native T1 and T2 mapping values with those of 20 normal controls. Results: Cardiac MRI was performed at 13.6 years of age (interquartile range [IQR] 11.9–16.4 years) and 8.2 months (IQR 6.8–9.6 months) following hospitalization. Twelve children displayed normal ejection fraction: left ventricle (LV) 57.2%, IQR 56.1–58.4; right ventricle (RV) 53.1%, IQR 52.0–55.7. One had low–normal LVEF (52%). They had normal extracellular volume (ECV) and normal T2 and native T1 times compared to controls. There was no qualitative evidence of edema. One child had late gadolinium enhancement (LGE) with normal ejection fraction, no edema, and normal T1 and T2 times. When stratifying children who had MIS-C according to history of LVEF <55% on echocardiography, there was no difference in MRI values. Conclusion: Although many children with MIS-C present acutely with cardiac dysfunction, residual myocardial damage 6–9 months afterward appears minimal. Long-term implications warrant further study.