Cardiovascular Features of Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

Multisystem Inflammatory Syndrome in Children (MIS-C) was a new condition with clinical features overlapping with Kawasaki disease (KD) observed during the COVID-19 pandemic. Differences emerged that supported distinguishing between the two conditions, including distinct cardiac presentations and sequelae. The study objective was to compare echocardiographic findings between MIS-C and KD utilizing prospectively collected longitudinal cohort data from a multicenter consortium and the Kawasaki Disease Research Center. Pre-COVID KD cases (2017–2019) and MIS-C cases (April 2020-March 2022) were analyzed for differences in coronary artery (CA) Z-score and left ventricular ejection fraction (EF) during admission and follow up. Relative risks (RRs) were calculated between disease category and cardiac presentation (diminished EF and aneurysm status). We analyzed 480 subjects (MIS-C n=262; KD n=218). KD subjects had a higher risk of CA aneurysm (RR= 1.86; 95% CI: 1.23, 2.79). Conversely, KD subjects had a lower risk of diminished EF (RR=0.09; 95% CI: 0.04, 0.18). Although most cardiovascular abnormalities resolved by follow-up, diminished EF persisted in 6 MIS-C patients (6%). None of the KD subjects had diminished EF at follow-up. CA Z-score ≥2.5 persisted in 3 MIS-C patients (10%) and 13 KD patients (25%). At follow-up, newly documented diminished EF was observed in 1 MIS-C subject, while a CA Z-score ≥2.5 was newly identified in 1 MIS-C subject and 2 KD subjects. MIS-C and KD demonstrate distinct cardiovascular phenotypes, with diminished EF more prominent in MIS-C and CA aneurysms more characteristic of KD. These findings support disease-specific approaches to cardiac monitoring and longitudinal follow-up.

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Journal
Pediatric Cardiology
Published
2026-11-05
DOI
https://doi.org/10.1007/s00246-026-04511-w
Primary Topic
Kawasaki Disease and Coronary Complications
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article
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article

Cardiovascular Features of Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

Laura J Fischer, David M. Brett‐Major, Samuel R. Dominguez, Alice I. Sato et al.
Pediatric Cardiology
Kawasaki Disease and Coronary Complications
article

Cardiovascular Features of Multisystem Inflammatory Syndrome in Children and Kawasaki Disease

Laura J Fischer, David M. Brett‐Major, Samuel R. Dominguez, Alice I. Sato, Arthur J. Chang, Michael D. Davis, Pei‐Ni Jone, Laura D’Addese, Abraham Degarege, Lerraughn M. Morgan, Adriana H. Tremoulet, Margalit E. Rosenkranz, Marian E. Melish, Joseph A. Bocchini, Jane C. Burns, Roberta L. DeBiasi, JoAnne E. Natale, Kirsten Dummer, Anne Heitzman Rowley, Negar Ashouri, Kari A. Simonsen, Jocelyn Y. Ang, Chisato Shimizu, James B. Wood, Maria del Pilar Gutierrez, Jianghu James Dong
article en

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) was a new condition with clinical features overlapping with Kawasaki disease (KD) observed during the COVID-19 pandemic. Differences emerged that supported distinguishing between the two conditions, including distinct cardiac presentations and sequelae. The study objective was to compare echocardiographic findings between MIS-C and KD utilizing prospectively collected longitudinal cohort data from a multicenter consortium and the Kawasaki Disease Research Center. Pre-COVID KD cases (2017–2019) and MIS-C cases (April 2020-March 2022) were analyzed for differences in coronary artery (CA) Z-score and left ventricular ejection fraction (EF) during admission and follow up. Relative risks (RRs) were calculated between disease category and cardiac presentation (diminished EF and aneurysm status). We analyzed 480 subjects (MIS-C n=262; KD n=218). KD subjects had a higher risk of CA aneurysm (RR= 1.86; 95% CI: 1.23, 2.79). Conversely, KD subjects had a lower risk of diminished EF (RR=0.09; 95% CI: 0.04, 0.18). Although most cardiovascular abnormalities resolved by follow-up, diminished EF persisted in 6 MIS-C patients (6%). None of the KD subjects had diminished EF at follow-up. CA Z-score ≥2.5 persisted in 3 MIS-C patients (10%) and 13 KD patients (25%). At follow-up, newly documented diminished EF was observed in 1 MIS-C subject, while a CA Z-score ≥2.5 was newly identified in 1 MIS-C subject and 2 KD subjects. MIS-C and KD demonstrate distinct cardiovascular phenotypes, with diminished EF more prominent in MIS-C and CA aneurysms more characteristic of KD. These findings support disease-specific approaches to cardiac monitoring and longitudinal follow-up.

Pediatric Cardiology
Northwestern University (US), University of Hawaiʻi at Mānoa (US), Lurie Children's Hospital (US), Children's Hospital of Orange County (US), Children's National (US), Central Michigan University (US), Wayne State University (US), George Washington University (US), The University of Texas at Tyler (US), Kapiolani Medical Center for Women and Children (US), Riley Hospital for Children (US), University of California San Diego (US), Rady Children's Hospital-San Diego (US), Willis-Knighton Cancer Center (US), Children's Hospital Colorado (US), Children's Hospital Central California (US), Children's Hospital of Pittsburgh (US), Children's Hospital of Michigan (US), Joe DiMaggio Children's Hospital (US), University of California Davis Medical Center (US), Indiana University Indianapolis (US), Indiana University School of Medicine (US), University of Colorado Anschutz Medical Campus (US), University of Nebraska Medical Center (US), University of California, Davis (US)
Openalex Percentile: Top 10%
Kawasaki Disease and Coronary Complications
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