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Cardiovascular Follow-up of Patients Treated for Multisystem Inflammatory Syndrome in Children (MIS-C)

November 15, 2023

Editor’s Note: Feria Ladha, MD, PhD (she/her/hers) is a resident physician in pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is an aspiring physician-scientist with research interests in cardiac genetics and developmental biology. - Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

In the past few years, individuals across the world have been affected by COVID-19, a serious and sometimes fatal disease caused by the SARS-CoV-2 coronavirus.

For some of our children, COVID-19 infection has resulted in multisystem inflammatory syndrome in children (MIS-C), which can cause multi-organ inflammation and result in shock, organ dysfunction, and even organ failure1. Up to 80% of patients who had MIS-C had cardiac manifestations, including myocarditis, coronary artery aneurysms, conduction abnormalities, and arrhythmias2. While most patients made a full recovery, the long-term cardiovascular effects in survivors of MIS-C with and without myocardial injury during acute illness remains unknown.

Dr. Dayna Zimmerman and colleagues from Children’s Hospital Los Angeles sought to evaluate the prevalence of long-term cardiovascular pathology in these patients in an article being early released in Pediatrics entitled, “Cardiovascular Follow-up of Patients Treated for MIS-C,” by using cardiac magnetic resonance imaging (CMR), cardiopulmonary exercise testing (CPET), and ambulatory rhythm monitoring in patients 6 months after they were treated for MIS-C (10.1542/peds.2023-063002).

The authors followed 69 patients, with 37 who had evidence of myocardial injury during acute illness, and during their MIS-C follow-up had had at least one of the cardiac studies performed. Similar rates of abnormalities in CMR, CPET, and ambulatory rhythm monitoring were identified in both those patients who had had evidence of myocardial injury during their acute illness and those who did not. These abnormalities included increases in cardiac extracellular volume indicating transient inflammation or fibrosis, reduced functional capacity, and rhythm abnormalities such as accelerated idioventricular rhythm.

While these results indicate the need for cardiology follow-up for all patients treated for MIS-C, it also highlights the importance of conducting follow-up studies to better understand the long-term effects of MIS-C.

This study provides novel insight into long-term cardiac abnormalities in patients who were diagnosed with MIS-C. I know that I will be sure to refer all of my patients with MIS-C for cardiology follow-up, regardless of initial cardiac involvement or illness severity.


  1. Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020;20(8):453-454.
  2. Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation. 2020;142(5):429-436.
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