208 - Occult coronary artery involvement in the absence of definite dilation in patients with multisystem inflammatory syndrome in children.

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 208
Publication Number: 208.203

Jeffrey Nafash, Cohen Children's Medical Center/Northwell Health, New York, NY, United States; Denise A. Hayes, Cohen Children's Medical Center, New Hyde Park, NY, United States; Joanna Fishbein, Northwell Health, Plainview, NY, United States

Presenting Author(s)

JN

Jeffrey Nafash, MD (he/him/his)

Pediatric Cardiology Fellow
Cohen Children's Medical Center/Northwell Health
New York, New York, United States

Background: Cardiac manifestations of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 include coronary artery (CA) dilation, noted in up to half of patients. However, the incidence of CA involvement may be underestimated, as patients may not meet the criteria for dilation but may have a wide variation in CA size during the illness. The long-term risks of CA involvement in MIS-C are not known.

Objective: We aimed to determine if subjects without definite CA dilation, but with significant CA z-score variation from acute illness to early recovery, had greater disease severity and higher inflammatory markers compared to those without this “occult” CA involvement.

Design/Methods: We reviewed all consecutive patients with MIS-C from 4/2020 to 11/2021. Subjects with true CA dilation (any z-score ≥ 2.5) or without early follow-up were excluded. “Occult CA involvement” was defined as a decrease in any CA z-score by ≥ 1.5 from initial hospitalization to an outpatient echocardiogram 2-8 weeks post-diagnosis. Peak vasoactive inotropic score (VIS), peak c-reactive protein (CRP), and additional secondary variables were compared between groups.

Results:

We identified 93 subjects (66.7% male): 31 (33.3%) with occult CA involvement, and 62 (66.7%) without. Subjects with occult CA involvement were older, mean age of 11.2 (±4.4) vs. 8.0 years (±4.0), p=0.001. Occult involvement was most common in the left anterior descending CA (23/31, 74.2%), followed by right CA in 15/31 (48.4%), and left main CA in 6/31 (19.4%). In these subjects, the mean z-score decrease was 2.07 (±0.39), 1.97 (±0.28), and 1.82 (±0.22), respectively.

Subjects with occult CA involvement had higher VIS, median 6.0 (0.0-15.0) vs. 0.0 (0.0-5.0), p=0.001. Subjects with occult CA involvement had significantly higher CRP, median 195 (165-297) vs. 148 (88-228), p=0.002. Significant associations were also noted between occult CA involvement and intensive care unit admission (p=0.015), a longer length of hospital stay (p=0.030), elevated high sensitivity troponin T (p< 0.001), and administration of fluid boluses (p=0.017) or vasoactive medications (p=0.005).

Conclusion(s): Occult CA involvement in MIS-C, suggested by wide variations in CA z-scores from acute illness to early recovery, is associated with higher VIS and CRP during initial hospitalization. More research is needed to determine if patients without CA dilation by current definitions, but with marked fluctuations in CA size, require long-term cardiovascular risk assessment similar to those with definite dilation.