Persistent long-term subclinical myocardial changes in multisystem inflammatory syndrome in children revealed by cardiac magnetic resonance and galectin-3

Table 1 Clinical features observed during acute presentation of multisystem inflammatory syndrome in children (n = 12)

Clinical characteristics		n (%)
Fever		12 (100.0)
GI manifestations	Abdominal pain	3 (25.0)
	Vomiting	4 (33.3)
	Loose stools	2 (16.7)
Cough		5 (41.1)
Respiratory distress		3 (25.0)
Conjunctival injection		5 (41.7)
Oral mucosal changes		1 (8.3)
Rash		7 (58.3)
Seizure		1 (8.3)
Skin peeling		3 (25.0)
Hypotension		7 (58.3)

GI: Gastrointestinal.

Table 2 Coronary artery dimensions and left ventricular ejection fraction assessed by 2D-echocardiography during acute presentation of multisystem inflammatory syndrome in children

LMCA diameter in mm (Z score)	LAD diameter in mm (Z score)	LCx diameter in mm (Z score)	RCA diameter in mm (Z score)	EF (%) (low: < 55%)
1.91 mm (-0.46Z)	2.12 mm (+0.03Z)	NA	2.1 mm (+0.21Z)	52
2.8 mm (-0.12Z)	2 mm (-0.5Z)	2.2 mm (-0.59Z)	2.4 mm (-0.33Z)	55
2.43 mm (+0.76Z)	2.01 mm (+0.24Z)	NA	1.88 mm (-1.41Z)	30
2.89 mm (-0.45Z)	2.45 mm (+0.13Z)	1.86 mm (-0.82Z)	2.37 mm (-0.85Z)	40
5.2 mm (+4.15Z)	3 mm (1.17Z)	NA	5 mm (+5.49Z)	35
2.5 mm (+0.3Z)	2 mm (+0.5Z)	1.5 mm (-0.63Z)	2.3 mm (+0.49Z)	50
2.8 mm (-0.62Z)	2.6 mm (+0.5Z)	1.01 mm (-2.02Z)	2.98 mm (+0.43Z)	55
3.3 mm (+2.96Z)	1.6 mm (-1.11Z)	NA	2.6 mm (+0.58Z)	35
2.30 mm (-1.5Z)	1.94 mm (-0.86Z)	1.86 mm (-0.97Z)	2.33 mm (-0.72Z)	60
2.6 mm (-1.21Z)	2.4 mm (-0.11Z)	2.1 mm (-0.63Z)	2.5 mm (-0.71Z)	55
2.17 mm (-0.75Z)	1.98 mm (+0.18Z)	2.11 mm (+0.98Z)	2.47 mm (+0.64Z)	55
3.3 mm (+1.94Z)	3.1 mm (+3.86Z)	2.6 mm (+1.62Z)	2.8 mm (+2.3Z)	30

Z-scores were calculated using Dallaire’s equations. Ejection fraction < 55% was considered reduced. EF: Ejection fraction; RCA: Right coronary artery; LMCA: Left main coronary artery; LAD: Left anterior descending artery; LCx: Left circumflex artery; NA: Not available.

Table 3 Coronary artery dimensions assessed by 2D-echocardiography at follow-up enrolment in patients with multisystem inflammatory syndrome in children

RCA diameter in mm (Z score)	LMCA diameter in mm (Z score)	LAD diameter in mm (Z score)	LCx diameter in mm (Z score)
2.7 mm (0.05Z)	3.2 mm (0.48Z)	2.5 mm (0.47Z)	2.2 mm (0.22Z)
2.9 mm (0.21Z)	3 mm (-0.2Z)	2.4 mm (-0Z)	2.2 mm (-0.3Z)
2.5 mm (-0Z)	2.6 mm (-0.5Z)	2.1 mm (-0.2Z)	2.7 mm (-0.6Z)
1.36 mm (-3.2Z)	2.5 mm (-1.7Z)	2.3 mm (-0.6Z)	2.1 mm (-0.8Z))
2.2 mm (-1.3Z)	2.5 mm (-1.5Z)	2.4 mm (-0.1Z)	2.6 mm (0.6Z)
2.1 mm (-0.5Z)	2.4 mm (-0.5Z)	2.3 mm (0.7Z)	1.6 mm (0.8Z)
3.8 mm (1.54Z)	4 mm (1.35Z)	3.3 mm (1.6Z)	3.1 mm (1.03Z)
3 mm (1.22Z)	2.7 mm (1.66Z)	2.8 mm (1.7Z)	2.8 mm (1.59Z)
3.2 mm (0.73Z)	3.2 mm (0.09Z)	3 mm (1.29Z)	2.5 mm (0.15Z)
2.85 mm (-0.5Z)	2.96 mm (-1Z)	2.33 mm (-0.7Z)	1.59 mm (-1.9Z)
2.6 mm (-0.2Z)	2.86 mm (-1.3Z)	2.7 mm (-1Z)	1.8 mm (-1.4Z)
2.7 mm (0.98Z)	3 mm (1.06Z)	2.3 mm (0.84Z)	2.2 mm (0.63Z)

All coronary Z-scores were within normal range at follow-up. RCA: Right coronary artery; LMCA: Left main coronary artery; LAD: Left anterior descending artery; LCx: Left circumflex artery.

Table 4 Cardiac magnetic resonance imaging parameters at follow-up (mean 23.6 months) in children with multi-system inflammatory syndrome in children

Parameters on MRI	mean ± SD, median (IQR)	Remarks
EDV (mL)	65.80 ± 16.07	-
	64.85 (51.62-76.33)
EDV Z scores	-1.72 ± 0.73	5 (42%) patients had EDV ≤ 2 Z score as per BSA
	-1.91
ESV (mL)	26.43 ± 5.92	-
	26.75 (20.4-30.25)
ESV Z scores	-0.56 ± 0.65	1 (8.3%) patient had ESV ≤ 2 Z score as per BSA
	-0.32
SV (mL)	41.27 ± 15.19	-
	33 (30.05-54.87)
SV Z scores	-1.52 ± 0.83	7 (58%) patients had SV ≤ 2 Z score as per BSA
	-2.02
CO (L/minute/m2)	3.54 ± 1.46	7 (58%) patients had CO lower than normal range (3.5-5 L/minute/m2)
	2.97 (2.42-4.8)
EF	58.34 ± 7.75	4 (33%) patients had EF < 55%
	58 (52.25-63.77)
T1 values (millisecond)	1173 ± 115	2 (16%) patients had T1 values > 1240 normal range (1021-1240)
	1195 (1171.25-1211.75)
T2 values (millisecond)	37.9 ± 2.64	-
	37 (35.50-40.00)
RWMA	-	All had no RWMA
LGE	-	No LGE were detected in any patients

MRI: Magnetic resonance imaging; IQR: Interquartile range; EDV: End diastolic volume; ESV: End systolic volume; SV: Stroke volume; CO: Cardiac output; BSA: Body surface area; EF: Ejection fraction; RWMA: Regional wall motion abnormality; LGE: Late gadolinium enhancement.