CMR Myocardial Changes in MIS-C: Admission Clinical Features and Longitudinal Findings.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2026-08-17 DOI:10.1016/j.jocmr.2026.102791

Sudeep D Sunthankar, Stephen E Hudson, Nicholas Joy, Joshua D Chew, William A McEachern, Kristen M George-Durrett, Gary W Coburn, Sophie E Katz, Anna E Patrick, Matthew L Dove, Olga Toro-Salazar, David A Parra, Jonathan H Soslow

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引用次数: 0

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a sequela of SARS-CoV-2 infection; however, longitudinal cardiac outcomes are unclear. Herein, we test the association between MIS-C biomarkers, inpatient echocardiographic features, and outcomes of interest: presence of myocarditis and myocardial delayed enhancement (MDE) on cardiac magnetic resonance (CMR). Furthermore, we describe the evolution of CMR features in MIS-C.

Methods: Patients diagnosed with MIS-C from 2020-2021 with CMR were included. Admission and serial biomarkers and echocardiographic features were collected. Primary outcomes measured were diagnosis of myocarditis (using modified Lake Louise criteria) and myocardial delayed enhancement (quantified by full width at half maximum method) on CMR. Secondary outcomes included abnormal LVEF on admission echocardiogram and changes in parametric mapping with serial CMR.

Results: A total of 66 patients were included (median age 9.7 IQR [7.2-14.7] years). Admission BNP (P=0.016), CRP (P=0.027), and ESR (P=0.002) associated with LV dysfunction on inpatient echocardiogram. CMR1 was obtained a median of 38 [26-61] days after hospital presentation. Myocarditis was present in 44% and MDE in 52% on CMR1, with median MDE burden of 10.8 [8.5-16.8]% in those affected. Inpatient echocardiographic features were not associated with presence of myocarditis or MDE. Admission ESR (P=0.031) associated with MDE. Admission platelets associated with myocarditis (P=0.040) and MDE (P=0.004). CMR2 (n=19), occurring a median of 11 [7-14] months after baseline CMR, demonstrated lower global T2 z-scores (P=0.035) without significant change in global T1 z-scores or ECV. Myocarditis (16% [3/19]) and MDE (28% [5/18]) were less frequent on CMR2.

Conclusions: For MIS-C patients, initial echocardiographic indices do not associate with myocarditis or MDE by CMR one month later; admission ESR and platelet levels may portend myocarditis or MDE on initial CMR. Reduced T2 z-score over serial CMR suggests resolving edema.

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MIS-C的CMR心肌改变：入院临床特征和纵向发现。

背景：儿童多系统炎症综合征（MIS-C）是SARS-CoV-2感染的后遗症；然而，纵向心脏结果尚不清楚。在此，我们测试了MIS-C生物标志物、住院患者超声心动图特征和相关结果之间的关联：心肌炎的存在和心脏磁共振（CMR）的心肌延迟增强（MDE）。此外，我们还描述了MIS-C中CMR特征的演变。方法：纳入2020-2021年CMR诊断为misc的患者。收集入院和系列生物标志物及超声心动图特征。测量的主要结果是CMR上心肌炎的诊断（使用改良的Lake Louise标准）和心肌延迟增强（用半最大全宽度法量化）。次要结果包括入院超声心动图LVEF异常和连续CMR参数映射的变化。结果：共纳入66例患者（中位年龄9.7 IQR[7.2-14.7]岁）。住院超声心动图显示，入院时BNP （P=0.016）、CRP （P=0.027）和ESR （P=0.002）与左室功能障碍相关。CMR1的中位时间为入院后38[26-61]天。CMR1患者心肌炎发生率为44%，MDE发生率为52%，中位MDE负担为10.8%[8.5-16.8]%。住院超声心动图特征与心肌炎或MDE的存在无关。入院ESR与MDE相关（P=0.031）。入院血小板与心肌炎（P=0.040）和MDE （P=0.004）相关。CMR2 (n=19)，发生在基线CMR后的中位时间为11[7-14]个月，总体T2 z-评分较低（P=0.035），总体T1 z-评分或ECV无显著变化。心肌炎（16%[3/19]）和MDE（28%[5/18]）在CMR2上的发生率较低。结论：对于misc患者，初始超声心动图指标与1个月后CMR心肌炎或MDE无关；入院时ESR和血小板水平可能预示心肌炎或MDE的初始CMR。连续CMR T2 z评分降低提示水肿缓解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.