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

The study titled “Echocardiographic Findings in Pediatric Multisystem Inflammatory Syndrome Associated With COVID-19 in the United States” provides crucial insights into the cardiovascular impact of MIS-C, a severe inflammatory syndrome in children associated with COVID-19.

Here’s a detailed summary:

Study Background

  • The research was conducted in response to the high incidence of Multisystem Inflammatory Syndrome in Children (MIS-C) reported in Europe and the United States, a severe condition related to COVID-19 in children​​.

Study Objectives and Methods

  • The objective was to analyze the echocardiographic manifestations in children with MIS-C.
  • The study involved a retrospective review of 28 children diagnosed with MIS-C, 20 healthy control subjects, and 20 patients with classic Kawasaki Disease (KD). Echocardiographic parameters were analyzed in the acute phase of both MIS-C and KD groups and during the subacute period (5.2 ± 3 days) in the MIS-C group​​.

Key Findings

  1. Coronary Artery Involvement: Only one case in the MIS-C group (4%) showed coronary artery dilation in the acute phase, which resolved in early follow-up. This finding contrasts with classic KD, where coronary artery involvement is more common.
  2. Left Ventricular Function: Both systolic and diastolic functions of the left ventricle, measured by deformation parameters, were worse in MIS-C patients compared to those with KD. This suggests significant myocardial involvement in MIS-C.
  3. Myocardial Injury: MIS-C patients with myocardial injury showed more pronounced functional impairment than those without myocardial injury across all functional parameters. The study identified specific echocardiographic parameters as strong predictors of myocardial injury in MIS-C, including global longitudinal strain, global circumferential strain, peak left atrial strain, and peak longitudinal strain of the right ventricular free wall.
  4. Recovery and Persistence of Dysfunction: During the subacute period, left ventricular ejection fraction (LVEF) generally returned to normal, indicating recovery of systolic function. However, diastolic dysfunction persisted, highlighting the potential for ongoing subclinical myocardial injury even after apparent recovery.


  • The study concludes that, unlike classic KD, coronary artery abnormalities are less common in early MIS-C. However, myocardial injury is a frequent finding. Even in patients with preserved LVEF, subtle changes in myocardial deformation were observed, suggesting subclinical myocardial injury.
  • The recovery of systolic function was noted during follow-up, but diastolic dysfunction persisted, indicating potential long-term cardiac implications for children affected by MIS-C.

In summary, this study sheds light on the cardiac effects of MIS-C in children, highlighting the importance of careful cardiac monitoring and follow-up in this patient population. It underscores the complexity of MIS-C and its distinction from other pediatric inflammatory conditions like Kawasaki Disease.

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