Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) often involves a post-viral myocarditis and associated left ventricular dysfunction. We aimed to assess myocardial function by strain echocardiography after hospital discharge and to identify risk factors for subacute myocardial dysfunction. We conducted a retrospective single-center study of MIS-C patients admitted between 03/2020 and 03/2021. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-ventricular circumferential strain (CS), and left atrial strain (LAS) were measured on echocardiograms performed 3-10 weeks after discharge and compared with controls. Among 60 MIS-C patients, hypotension (65%), ICU admission (57%), and vasopressor support (45%) were common, with no mortality. LVEF was abnormal (< 55%) in 29% during hospitalization but only 4% at follow-up. follow-up strain abnormalities were prevalent (gls abnormal in 13%, 4c-ls in 18%, cs in 16%, las in 5%). hypotension, icu admission, icu and hospital length of stay, and any lvef >< 55% during hospitalization were factors associated with lower strain at follow-up. higher peak c-reactive protein (crp) was associated with hypotension, icu admission, total icu days, and with lower follow-up gls (r =" - 0.55;" p =" 0.01)" and cs (r =" 0.41;" p =" 0.02)." peak crp >< 18 mg dl had negative predictive values of 100% and 88% for normal follow-up gls and cs, respectively. a subset of mis-c patients demonstrate subclinical systolic and diastolic function abnormalities at subacute follow-up. peak crp during hospitalization may be a useful marker for outpatient cardiac risk stratification. mis-c patients with hypotension, icu admission, any lvef >< 55% during hospitalization, or a peak crp > 18 mg/dL may warrant closer monitoring than those without these risk factors.
