Skip to main content
SpringerLink
Log in

Evolution of Cardiovascular Findings in Multisystem Inflammatory Syndrome in Children (MIS-C) Across COVID-19 Variants: Common Trends and Unusual Presentations

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition following COVID-19 infection. Cardiac involvement is common and includes left ventricular systolic dysfunction, cardiac marker elevation, electrocardiogram (ECG) changes, and coronary artery dilation. This single-center retrospective cohort study compares cardiovascular disease between three major SARS-CoV-2 variants and describes the evolution of findings in medium-term follow-up. Of 69 total children (mean age 9.2 years, 58% male), 60 (87%) had cardiovascular involvement with the most common features being troponin elevation in 33 (47%) and left ventricular dysfunction in 22 (32%). Based on presumed infection timing, 61 patients were sorted into variant cohorts of Alpha, Delta, and Omicron. Hospitalization was longer for the Delta group (7.7 days) vs Alpha (5.1 days, p = 0.0065) and Omicron (4.9 days, p = 0.012). Troponin elevation was more common in Delta compared to Alpha (13/20 vs 7/25, p = 0.18), and cumulative evidence of cardiac injury (echocardiographic abnormality and/or troponin elevation) was more common in Delta (17/20) compared with Alpha (12/25, p = 0.013) or Omicron (8/16, p = 0.034). Forty-nine (77%) of the original cohort (n = 69) had no cardiac symptoms or findings beyond 3 months post-hospitalization. Cardiac MRI was performed in 28 patients (between 3 and 6 months post-hospitalization) and was normal in 25 patients (89%). The differences in the variant cohorts may be due to alteration of the immune landscape with higher severity of COVID-19 infection. Despite overall reassuring cardiac outcomes, it is important to note the variability of presentation and remain vigilant with future variants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

No datasets were generated or analyzed during the current study.

Abbreviations

MIS-C:

Multisystem inflammatory syndrome in children

ECG:

Electrocardiogram

CDC:

Center for disease control

MRI:

Magnetic resonance imaging

References

  1. Jone PN et al (2022) SARS-CoV-2 infection and associated cardiovascular manifestations and complications in children and young adults: a scientific statement from the American Heart Association. Circulation 145(19):e1037–e1052

    Article  CAS  PubMed  Google Scholar 

  2. Feldstein LR et al (2020) Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 383(4):334–346

    Article  CAS  PubMed  Google Scholar 

  3. Sperotto F et al (2021) Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr 180(2):307–322

    Article  CAS  PubMed  Google Scholar 

  4. Alali A et al (2022) Vasoplegic shock represents a dominant hemodynamic profile of multisystem inflammatory syndrome following COVID-19 in children and adolescents. Pediatr Crit Care Med 23(6):e295–e299

    Article  PubMed  PubMed Central  Google Scholar 

  5. Choe YJ et al (2023) Change in severity and clinical manifestation of MIS-C over SARS-CoV-2 variant outbreaks in Korea. J Korean Med Sci 38(30):e225

    Article  PubMed  PubMed Central  Google Scholar 

  6. Laird-Gion J et al (2023) MIS-C across three SARS-CoV-2 variants: changes in COVID-19 testing and clinical characteristics in a cohort of U.S. children. Eur J Pediatr 182(6):2865–2872

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Koelle K et al (2022) The changing epidemiology of SARS-CoV-2. Science 375(6585):1116–1121

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kaltman J et al (2023) Six-month cardiac outcomes in children with multisystem inflammatory syndrome in children. Cardiol Young, pp 1–7

  9. Villacis-Nunez DS et al (2021) Giant coronary aneurysms in multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. JACC Case Rep 3(13):1499–1508

    Article  PubMed  PubMed Central  Google Scholar 

  10. Farooqi KM et al (2021) Longitudinal outcomes for multisystem inflammatory syndrome in children. Pediatrics 148(2)

  11. Nishikubo T et al (2023) The first case in Japan of fulminant myocarditis due to multisystem inflammatory syndrome in children (MIS-C) that required mechanical circulatory support. Int Heart J 64(4):783–788

    Article  PubMed  Google Scholar 

  12. Sliwka J et al (2022) Heart transplantation as a result of pediatric inflammatory multisystem syndrome in an adolescent. Transplant Proc 54(4):1167–1168

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. McAree D et al (2023) Multisystem inflammatory syndrome in children (MIS-C): reduced exercise duration and capacity at six month follow-up. Pediatr Cardiol

  14. Information for healthcare providers about multisystem inflammatory syndrome in children (MIS-C). https://www.cdc.gov/mis/mis-c/hcp/index.html. Accessed 2023

  15. CDC museum COVID-19 timeline. https://www.cdc.gov/museum/timeline/covid19.html. Accessed 2023

  16. Wu EY, Campbell MJ (2021) Cardiac manifestations of multisystem inflammatory syndrome in children (MIS-C) following COVID-19. Curr Cardiol Rep 23(11):168

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tabatabai M et al (2023) An analysis of COVID-19 mortality during the dominancy of alpha, delta, and omicron in the USA. J Prim Care Commun Health 14:21501319231170164

    Article  Google Scholar 

  18. Sacco K et al (2022) Immunopathological signatures in multisystem inflammatory syndrome in children and pediatric COVID-19. Nat Med 28(5):1050–1062

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Zambrano LD et al (2022) Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12–18 years—United States, July-December 2021. MMWR Morb Mortal Wkly Rep 71(2):52–58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Chin SE et al (2022) Cardiac complications associated with COVID-19, MIS-C, and mRNA COVID-19 vaccination. Pediatr Cardiol 43(3):483–488

    Article  PubMed  PubMed Central  Google Scholar 

  21. Levy M et al (2022) Multisystem inflammatory syndrome in children by COVID-19 vaccination status of adolescents in France. JAMA 327(3):281–283

    Article  CAS  PubMed  Google Scholar 

  22. Zhang HP et al (2023) Recent developments in the immunopathology of COVID-19. Allergy 78(2):369–388

    Article  CAS  PubMed  Google Scholar 

  23. La Torre F et al (2023) Multi-inflammatory syndrome in children (MIS-C) in 2023: is it time to forget about it? Children 10(6):980

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health Sciences, Los Angeles, CA, USA

    Rabia S. Khan

  2. Department of Pediatrics, UCI Health, Orange, CA, USA

    Theadora Ordog

  3. Division of Pediatric Rheumatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Sandy D. Hong

  4. Division of Hospital Medicine, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Anna H. Schmitz

  5. Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Bijoy Thattaliyath

  6. Division of Pediatric Hematology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Anjali A. Sharathkumar

Authors
  1. Rabia S. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theadora Ordog
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandy D. Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna H. Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bijoy Thattaliyath
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anjali A. Sharathkumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RSK and TO conceived of the research question, performed the data analysis, and wrote the initial draft of the manuscript. SDH, AHS, BT, and AAS assisted in refining the research methods and critically reviewed and contributed to the final draft of the manuscript.

Corresponding author

Correspondence to Rabia S. Khan.

Ethics declarations

Conflict of interest

There are no relevant financial disclosures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 17 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khan, R.S., Ordog, T., Hong, S.D. et al. Evolution of Cardiovascular Findings in Multisystem Inflammatory Syndrome in Children (MIS-C) Across COVID-19 Variants: Common Trends and Unusual Presentations. Pediatr Cardiol 45, 552–559 (2024). https://doi.org/10.1007/s00246-023-03397-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-023-03397-2

Keywords

Search

Navigation