Significant Cardiac and Respiratory Limitations in asymptomatic Post COVID MIS-C Myocarditis Patients
2Paediatric Cardiology unit, Padeh-Poriya Medical Center, ישראל
3Pediatric Cardiology Institute, Ruth Children’s Hospital, Rambam Health Care Center, ישראל
4Pediatric Pulmonary Institute, Ruth Children’s Hospital, Rambam Health Care Center, ישראל
5Faculty of Medicine, The Technion Institute of Technology, ישראל
6Department of physical therapy, Faculty of Social Welfare and Health science, University of Haifa, ישראל
Background: Myocarditis is one of the presentations of Multisystemic Inflammatory Syndrome in Children (MIS-C) following Coronavirus disease 2019 (COVID 19). Good short term prognosis is reported, however, data regarding medium term functional capacity and limitations is scarce.
Objectives: To evaluate exercise capacity and possible limitations in asymptomatic children post myocarditis caused by MIS-C following COVID 19.
Methods: Children with post MIS-C myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET) and compared with age, sex, weight and activity level matched control group.
Results: Twenty-eight children (14 with MIS-C and 14 control) completed CPET. Peak oxygen uptake (peak VO2) were within the normal range in both groups (MIS-C 89±8.9% and Control 87±13.7% of predicted VO2), however in the MIS-C group 10 patients (71%) presented specific cardiovascular of respiratory limitations, compared to 4 patients (29%) in the control group. The MIS-C group included 2 patients had oxygen pulse flattening representing cardiovascular limitation (Vs. none in the control group), 3 patients with exercise induced hypoxemia (Vs. none), 5 patients with low breathing reserve (Vs. 3) and 3 with low FEV1 (Vs. 1 in the control group).
Conclusions: Post MIS-C myocarditis paediatric patients may present with exercise limitations although asymptomatic and normal usual cardiac evaluation. Functional assessment (e.g. CPET) should be considered as part of the routine examination before returning to normal active routine in children post MIS-C myocarditis.