Multisystem inflammatory syndrome impact on the cardiovascular system: Single-centre study of Latvia = Multisistēmu iekaisuma sindroma ietekme uz sirds un asinsvadu sistēmu: Latvijas viena centra pētījums

MIS-C (Multisystem inflammatory syndrome in children) is a hyperinflammatory syndrome caused by the Sars-CoV-2 virus, still an ongoing issue worldwide. MIS-C is associated with an impairment of various organ systems, including the cardiovascular system, and up to 100% of all MIS-C patients have a broad spectrum and severity of symptoms. Identifying MIS-C early and starting therapy is crucial to minimise possible complications and clinical worsening. A prospective cohort study in a single centre was conducted at the Children’s Clinical University Hospital in Latvia from January to December 2021. Patients between the ages of one and seventeen years who met the MIS-C criteria were included in the study. We evaluated the patient’s demographic data, blood pressure, echocardiographic data, ESG data, and cardiac biomarkers such as proBNP and troponin I. Thirty-one patients were included who met the MIS-C criteria. The median age was 8.0 years, and 52% were boys. Of all patients, 77% initially presented with hypotension, and 42% required inotropic support. Treatment in the paediatric intensive care unit (PICU) was required in 58% of patients. Reduced left ventricular ejection fraction was observed in 35% of patients. Mildly decreased ventricular ejection fraction (< 55%) was observed in 19% of cases, and moderate dysfunction (ejection fraction < 45%) in 16% of patients. Twelve per cent of patients received milrinone to improve left heart function. Left heart function significantly improved in all patients during the hospitalisation. In 6% of all patients, coronary artery dilations were observed. All patients had dilation resolution at the time of discharge. The median length of hospitalisation was twelve days, and the median length of PICU stay was three days. Multisystem inflammatory syndrome in children is a significant and potentially life-threatening illness with cardiovascular involvement in 100% of cases. Patients who present primarily with higher ProBNP levels are more likely to have decreased left ventricle ejection fraction, which should be kept in mind when evaluating patients with MIS-C. Overall, patients with MIS-C have a good prognosis, and most cardiovascular changes have been resolved by discharge, but further follow-up and studies are needed to judge the long-term outcome. [ABSTRACT IN LATVIAN] MIS-C (Multisystem inflammatory syndrome in children) ir hiperinflamators sindroms, ko izraisa Sars-CoV-2 vīruss. MIS-C joprojām ir aktuāla problēma visā pasaulē. Ir zināms, ka MIS-C ietekmē dažādas orgānu sistēmas, tai skaitā kardiovaskulāro sistēmu, līdz pat 100% gadījumu ar dažādu simptomu spektru un smagumu. Ir ļoti svarīgi laikus identificēt MIS-C un sākt terapiju, lai samazinātu iespējamās komplikācijas un klīnisko pasliktināšanos. Šis bija viena centra prospektīvs kohortas pētījums, kas tika veikts Bērnu klīniskajā universitātes slimnīcā no 2021. gada janvāra līdz decembrim. Pētījumā tika iekļauti pacienti vecumā no viena līdz septiņpadsmit gadu vecumam, kuri atbilda MIS-C kritērijiem. Mēs izanalizējām pacientu demogrāfiskos datus, asinsspiedienu, ehokardiogrāfiju, elektrokardiogrāfiju, kā arī sirds biomaríierus: proBNP un troponīnu I. Pētījumā tika iekļauti 31 pacients, kuri atbilda MIS-C kritērijiem. Vidējais pacientu vecums bija 8,0 gadi un 52% bija zēni. No visiem pacientiem 77%, iestājoties uzņemšanas nodaļā, tika konstatēta hipotensija. No visiem pacientiem 42% bija nepieciešams inotropu medikamentu atbalsts. Ārstēšana intensīvās terapijas nodaļā bija nepieciešama 58% no visiem pacientiem. Samazināta kreisā kambara izsviedes frakcija tika novērota 35%, viegli samazināta kambara izsviedes frakcija (LV EF < 55%) tika novērota 19% gadījumu, bet mēreni samazināta izsviedes frakcija (LV EF < 45%) tika novērota 16% pacientu. Divpadsmit procenti pacientu saņēma milrinonu, lai uzlabotu sirds kreisās puses funkciju. Hospitalizācijas laikā visiem pacientiem būtiski uzlabojās sirds kreisās puses funkcija. No visiem pētījumā iekļautajiem pacientiem sešiem procentiem tika novērota koronāro artēriju dilatācija. Visiem pacientiem, izrakstoties no stacionāra, koronāro artēriju dilatācija bija izzudusi.