ArticleCardiac Findings of Multisystem Inflammatory Syndrome in Children (MIS-C) with Corona Virus Disease 2019 (COVID-19)
Tahera Nazrin* , M. Quamrul Hassan, Azmeri U H
Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is an emerging serious consequence or association of COVID 19 disease in children. Along with its acute presentation, MIS-C threatens the patient and clinician alike for its multiple organ or system involvement, specially the heart. We describe cardiac changes of hospitalized MIS-C patients in Asian children, their short-term outcome by early or late presentation and onset of treatment in Evercare Hospital Dhaka, Bangladesh. Methods: This observational study has been conducted at Evercare Hospital Dhaka on 15 patients with MIS-C. As part of ongoing MIS-C surveillance project, clinically suspected children attending outpatient and emergency room were screened and admitted for further evaluation and management. Cardiac evaluation of those children involved detail echocardiography. Other relevant demographic, clinical data and laboratory data have been collected from hospital surveillance record from 15th May to 30th July 2020. Results: Among 15 patients, male: female was 1.14, age range 0.3 to 14 years with median age 4 yrs. Out of 15 children, 5 (33.33%) were COVID-19 RT-PCR positive and 10 (66.66%) had strong contact history with COVID 19 patients. All of them had fever at presentation. On clinical evaluation, 5 (33.33%) children had heart failure with hypotension, 5 (33.33%) had myocarditis and 3(19.8%) were in shock. Troponin I and S. Pro BNP were elevated in 7(46.67%) and 5(33.33%) cases respectively. Detail cardiac study yielded Coronary Artery Aneurysm (CAA) in 12(79.92%) and 9(59.94%) had irregular coronary vascular wall. There were left ventricular dysfunction in 5(33.3%), mitral regurgitation in 2(13.32%) and trace pericardial effusion in 1 (6.66%) cases. Medium aneurysms of Left Main Coronary Artery(LMCA) and Left Anterior Descending Artery (LAD) were found in (13.33%) patients .Small aneurysms were observed in LMCA and LAD and Right Coronary Artery (RCA) in 10 (66.6 %), 7(46.62 %) and 5 (33.3%) children respectively. One patient (6.66%) had dilated LAD. All received traditional treatment. Those with coronary artery changes arriving late and getting treatment at > day 7 of illness (Group A, 9/12, 75%), did not have their coronary artery aneurysm with irregular vascular wall back to normal even at 4-8 weeks of follow up. Group B (3/12, 25%) with coronary artery changes admitted early and treated ≤7 days of illness, had good echocardiographic outcome. Conclusion: Our observational study documented that children who came to hospital after one week of illness with coronary artery aneurysm, irregular coronary vascular wall, myocarditis, heart failure or cardiogenic shock, their response to treatment were delayed or poor based on follow up echocardiography. Further follow up studies and longer surveillance of the MIS-C patients are required to observe the long-term outcome of their coronary artery status and cardiac complications.
MIS-C, COVID-19, SARS-CoV-2, Coronary artery aneurysm, Kawasaki disease.