Echocardiographic Findings in Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 in the United States

J Am Coll Cardiol. 2020 Oct 27;76(17):1947-1961. doi: 10.1016/j.jacc.2020.08.056. Epub 2020 Sep 2.


Background: Centers from Europe and United States have reported an exceedingly high number of children with a severe inflammatory syndrome in the setting of coronavirus disease 2019, which has been termed multisystem inflammatory syndrome in children (MIS-C).

Objectives: This study aimed to analyze echocardiographic manifestations in MIS-C.

Methods: A total of 28 MIS-C, 20 healthy control subjects and 20 classic Kawasaki disease (KD) patients were retrospectively reviewed. The study reviewed echocardiographic parameters in the acute phase of the MIS-C and KD groups, and during the subacute period in the MIS-C group (interval 5.2 ± 3 days).

Results: Only 1 case in the MIS-C group (4%) manifested coronary artery dilatation (z score = 3.15) in the acute phase, showing resolution during early follow-up. Left ventricular (LV) systolic and diastolic function measured by deformation parameters were worse in patients with MIS-C compared with KD. Moreover, MIS-C patients with myocardial injury were more affected than those without myocardial injury with respect to all functional parameters. The strongest parameters to predict myocardial injury in MIS-C were global longitudinal strain, global circumferential strain, peak left atrial strain, and peak longitudinal strain of right ventricular free wall (odds ratios: 1.45 [95% confidence interval (CI): 1.08 to 1.95], 1.39 [95% CI: 1.04 to 1.88], 0.84 [95% CI: 0.73 to 0.96], and 1.59 [95% CI: 1.09 to 2.34], respectively). The preserved LV ejection fraction (EF) group in MIS-C showed diastolic dysfunction. During the subacute period, LVEF returned to normal (median from 54% to 64%; p < 0.001) but diastolic dysfunction persisted.

Conclusions: Unlike classic KD, coronary arteries may be spared in early MIS-C; however, myocardial injury is common. Even preserved EF patients showed subtle changes in myocardial deformation, suggesting subclinical myocardial injury. During an abbreviated follow-up, there was good recovery of systolic function but persistence of diastolic dysfunction and no coronary aneurysms.

Keywords: COVID-19; coronary artery abnormality; deformation; echocardiography; multisystem inflammatory syndrome in children (MIS-C); myocarditis.

MeSH terms

  • Adolescent
  • Betacoronavirus
  • COVID-19
  • Child
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnostic imaging
  • Coronavirus Infections / physiopathology
  • Echocardiography*
  • Female
  • Heart / physiopathology*
  • Humans
  • Male
  • Mucocutaneous Lymph Node Syndrome / diagnostic imaging
  • Mucocutaneous Lymph Node Syndrome / physiopathology
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / physiopathology
  • Retrospective Studies
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome / diagnostic imaging*
  • Systemic Inflammatory Response Syndrome / physiopathology

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related