tetano
Editor, Senior Moderator
Eur J Pediatr
. 2026 Feb 20;185(3):140.
doi: 10.1007/s00431-026-06798-6.
Post-MIS-C cardiovascular outcomes: a systematic review
Giancarlo Alvarado-Gamarra[SUP] 1 2 [/SUP], Katherine Alcala-Marcos[SUP] 3 [/SUP], Carlos R Celis[SUP] 4 [/SUP], Pía Balmaceda-Nieto[SUP] 5 [/SUP], Luigi Cieza[SUP] 4 [/SUP], Cristian Morán-Mariños[SUP] 6 [/SUP], Pamela Grados-Espinoza[SUP] 7 [/SUP], Carlos Alva-Díaz[SUP] 8 9 [/SUP], Lucie Ecker[SUP] 4 10 [/SUP], Theresa J Ochoa[SUP] 10 11 [/SUP], Luis Miguel Franchi[SUP] 4 [/SUP], Leigh M Howard[SUP] 12 [/SUP], Carlos G Grijalva[SUP] 12 [/SUP], Claudio F Lanata[SUP] 4 13 [/SUP]
Affiliations
Limited knowledge and variability in findings exist regarding the resolution of cardiovascular outcomes following Multisystem Inflammatory Syndrome in Children (MIS-C). We conducted a systematic review to estimate the frequency of cardiovascular outcomes following MIS-C. A systematic search was conducted in Pubmed/Medline, Scopus, Embase, SciELO, LILACS, Cochrane Library, Web of Science, and medRxiv were searched up to February 2024. We included studies reporting cardiovascular events that began in acute MIS-C and persisted after discharge. Screening and data extraction were performed by independent reviewers. We performed a random-effects meta-analysis and assessed the certainty of the evidence using the GRADE approach. Eighty-four studies (n = 4,778) were included; seven had a comparator group. The frequency of cardiovascular outcomes-including coronary abnormalities (Z-score ≥ 2), left ventricle ejection fraction < 55%, diastolic dysfunction, myocarditis, and pericardial effusion-decreased over time, with most resolving by 6 to 9 months. However, cardiac magnetic resonance imaging studies identified myocardial edema and/or fibrosis persisting up to 12 months, and two studies reported coronary abnormalities at 18- to 24-month follow-up. Evidence certainty was very low. Compared to children with COVID-19 or healthy controls, MIS-C showed more cardiovascular events and greater subclinical myocardial dysfunction, as assessed by strain analysis, during a 6-month follow-up. Compared with other etiologies of myocarditis, MIS-C myocarditis was associated with better cardiovascular outcomes but shorter exercise duration and lower aerobic capacity on stress testing. Conclusions: Cardiovascular outcomes following MIS-C improved over time, but certain subclinical cardiac abnormalities persisted up to 12 to 24 months. These findings may support long-term follow-up after MIS-C.Trial registration: Protocol registration number: PROSPERO, CRD42022336784.
Keywords: Coronary aneurysm; Long-term care; Pediatric multisystem inflammatory disease, COVID-19 related; Pediatrics.
. 2026 Feb 20;185(3):140.
doi: 10.1007/s00431-026-06798-6.
Post-MIS-C cardiovascular outcomes: a systematic review
Giancarlo Alvarado-Gamarra[SUP] 1 2 [/SUP], Katherine Alcala-Marcos[SUP] 3 [/SUP], Carlos R Celis[SUP] 4 [/SUP], Pía Balmaceda-Nieto[SUP] 5 [/SUP], Luigi Cieza[SUP] 4 [/SUP], Cristian Morán-Mariños[SUP] 6 [/SUP], Pamela Grados-Espinoza[SUP] 7 [/SUP], Carlos Alva-Díaz[SUP] 8 9 [/SUP], Lucie Ecker[SUP] 4 10 [/SUP], Theresa J Ochoa[SUP] 10 11 [/SUP], Luis Miguel Franchi[SUP] 4 [/SUP], Leigh M Howard[SUP] 12 [/SUP], Carlos G Grijalva[SUP] 12 [/SUP], Claudio F Lanata[SUP] 4 13 [/SUP]
Affiliations
- PMID: 41721085
- DOI: 10.1007/s00431-026-06798-6
Limited knowledge and variability in findings exist regarding the resolution of cardiovascular outcomes following Multisystem Inflammatory Syndrome in Children (MIS-C). We conducted a systematic review to estimate the frequency of cardiovascular outcomes following MIS-C. A systematic search was conducted in Pubmed/Medline, Scopus, Embase, SciELO, LILACS, Cochrane Library, Web of Science, and medRxiv were searched up to February 2024. We included studies reporting cardiovascular events that began in acute MIS-C and persisted after discharge. Screening and data extraction were performed by independent reviewers. We performed a random-effects meta-analysis and assessed the certainty of the evidence using the GRADE approach. Eighty-four studies (n = 4,778) were included; seven had a comparator group. The frequency of cardiovascular outcomes-including coronary abnormalities (Z-score ≥ 2), left ventricle ejection fraction < 55%, diastolic dysfunction, myocarditis, and pericardial effusion-decreased over time, with most resolving by 6 to 9 months. However, cardiac magnetic resonance imaging studies identified myocardial edema and/or fibrosis persisting up to 12 months, and two studies reported coronary abnormalities at 18- to 24-month follow-up. Evidence certainty was very low. Compared to children with COVID-19 or healthy controls, MIS-C showed more cardiovascular events and greater subclinical myocardial dysfunction, as assessed by strain analysis, during a 6-month follow-up. Compared with other etiologies of myocarditis, MIS-C myocarditis was associated with better cardiovascular outcomes but shorter exercise duration and lower aerobic capacity on stress testing. Conclusions: Cardiovascular outcomes following MIS-C improved over time, but certain subclinical cardiac abnormalities persisted up to 12 to 24 months. These findings may support long-term follow-up after MIS-C.Trial registration: Protocol registration number: PROSPERO, CRD42022336784.
Keywords: Coronary aneurysm; Long-term care; Pediatric multisystem inflammatory disease, COVID-19 related; Pediatrics.