Prediction and Course of Diastolic Dysfunction in COVID-19 Associated Pediatric Multisystem Inflammatory Syndrome

Background: To predict the risk for diastolic dysfunction on admission and assess repetitive cardiac function during the follow-up of individuals diagnosed with multisystem inflammatory syndrome associated with COVID-19 (MIS-C). Methods: This prospective, single-center study comprises patients who were divided into two groups: Mitral E/e'>= 8 and mitral E/e' < 8 on the first admission. During follow-up, patients underwent repeated echocardiography (on the first admission and at 1 week, 1 month, and 3 months post-procedure) between December 2020 and June 2022. Results: Among the 92 patients included in this study, 32 are females. Procalcitonin, erythrocyte sedimentation rate, B-type natriuretic peptide (proBNP), ferritin, and interleukin-6 (IL-6) values were found to be significantly higher in the E/e' >= 8 groups than that in the mitral valve E/e'<8 groups (P < 0.05). The mitral valve e', a', s,' and tricuspid valve a', s,' TAPSE, and septal e,' a' values in the mitral valve E/e'>= 8 groups were found to be significantly lower than that in the E/e' < 8 groups, whereas mitral valve E, isovolumic contraction time (ICT), isovolumic relaxation time (IRT), myocardial performance Index (MPI), and tricuspid valve ICT, IVA, E/e', and septal ICT, IVA, IRT, MPI values were found to be significantly higher (P < 0.05). Serial assessments of mitral valve E, tricuspid valve E, e', E/e,' septal ST, MPI, and left ventricular EF, FS values revealed statistically significant variations (P < 0.05). The receiver operating characteristic (ROC) curve analysis revealed an IL-6 of > 70.3, proBNP of > 278.5, and procalcitonin of > 2.4 was identified as an effective cut-off point in the mitral E/e'(> 8) for patients with MIS-C area under the curve (AUC) = 0.743, 95% confidence interval (CI) = 0.599 - 0.887, P = 0.005, sensitivity: 72%, specificity: 74% for IL-6; AUC = 0.680, 95% CI = 0.535 - 0.825, P = 0.037, sensitivity: 72%, specificity: 60% for proBNP; and AUC = 0.672, 95% CI = 0.528 - 0.816, P = 0.046, sensitivity: 72%, specificity: 60% for procalcitonin). Conclusions: Tissue Doppler imaging findings of diastolic dysfunction seem to be improved until the third month. Tissue Doppler imaging findings of diastolic dysfunction appear to ameliorate until the third month. Mitral valve E/e'> 8 value is significantly associated with IL-6, proBNP, and procalcitonin values in patients with MIS-C. IL-6, proBNP, and procalcitonin values were determined as independent high-risk indicators for left ventricular diastolic dysfunction.