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Misra et al. Vessel Plus 2022;6:14 https://dx.doi.org/10.20517/2574-1209.2021.89 Page 9 of 11

The most effective treatment for MIS-C continues to be debated. A recent multi-center study showed that
IVIG and glucocorticoid therapy for patients with MIS-C compared to IVIG by itself is potentially
[30]
correlated with a lower likelihood for systolic myocardial dysfunction ; however, an international cohort
study has suggested no differences in short term outcomes when comparing IVIG plus steroids to IVIG or
steroids by themselves .
[31]

CARDIAC OUTCOMES
Given the recent appearance of an MIS-C as a clinical entity, the illness’s long-term cardiac outcomes on
patients are unclear; however, recent studies have evaluated the short-term outcomes of these patients.
Valvular regurgitation, pericarditis, and dysrhythmias appear to resolve within 10 weeks after initial
[7]
diagnosis . Additionally, left ventricular ejection fraction appears to normalize in most patients by 10 weeks
follow up; however, 25% of patients had persistently reduced left ventricular global longitudinal strain at 10
weeks follow up . A more recent study of 46 patients from the UK noted 44 patients with normal
[7]
echocardiograms at 6 months follow up, with two patients having coronary enlargement that was persistent
[32]
[32]
on follow up . All patients had normal left ventricular systolic function .
At this time, it is unclear what the risk factors for cardiac dysfunction in MIS-C are. However, our group’s
research suggests that patients with persistently low left ventricular strain at their initial presentation
echocardiogram are at risk for persistent cardiac dysfunction at 10 weeks follow up . The National
[7]
Institutes of Health has recently allocated funding for a prospective study looking at patients with MIS-C,
deemed the “Long-Term Outcomes after the Multisystem Inflammatory Syndrome in Children” Trial, or
MUSIC, to follow patients over 5 years. The study is currently recruiting participants across different
centers in the United States.

CONCLUSION
In conclusion, MIS-C can lead to significant morbidity and mortality and is associated with multiple
cardiovascular manifestations. However, prompt identification and management of these patients can lead
to satisfactory outcomes for these patients. At this time, the long-term cardiovascular risk factors for these
patients are uncertain, but it appears that most patients are asymptomatic at least 10 weeks follow up.

DECLARATIONS
Acknowledgements
We acknowledge the dedicated work of our pediatric cardiac sonographers in the acquisition of
echocardiograms in all the patients with MIS-C and our team of nurses, respiratory therapists, patient care
associates, fellows, residents, and clinicians who worked together to care for these patients.

Authors’ contribution
Performed reference collection and wrote the manuscript: Misra A, Safa R, Sanil Y, Blake JM,
Charaf Eddine A, Balakrishnan P, Garcia RU
Re-edited the manuscript: Aggarwal S, Singh G

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.