Persistent Heart Dysfunction Rare Six Months After Pediatric Inflammatory Syndrome

Persistent left ventricular systolic dysfunction was infrequently observed among children reassessed by echocardiography at least six months following SARS-CoV-2–associated multisystem inflammatory syndrome in children, according to a systematic review and rare-event meta-analysis. Across ten observational cohorts evaluating 432 pediatric patients who underwent late imaging, only three children experienced lingering left ventricular systolic impairment, corresponding to a crude observed proportion of 0.69 percent.

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 frequently involves acute myocardial dysfunction, but the prevalence of persistent left ventricular systolic dysfunction at longer-term follow-up remained uncertain. To resolve this question, researchers conducted a comprehensive review and quantitative synthesis of observational cohort studies tracking longitudinal echocardiographic follow-up in children and adolescents younger than 21 years with SARS-CoV-2–associated condition.

The investigation prespecified persistent left ventricular systolic dysfunction as its primary endpoint, established objectively as a left ventricular ejection fraction of less than 55 percent at six months or longer after initial illness. Study-level events and population counts were extracted and standardized by using the specific number of children who completed echocardiography at or beyond the six-month mark as the endpoint-specific denominator for analysis.

To synthesize the sparse event data without introducing artificial continuity adjustments, the primary pooled prevalence was calculated using an intercept-only binomial logistic-normal generalized linear mixed model fitted directly to study-level event counts and denominators. This continuity-correction-free model yielded a pooled prevalence of 0.69 percent, with a 95 percent confidence interval spanning from 0.22 percent to 2.13 percent. The authors cautioned that because only three total events were observed across all cohorts, this model-based calculation should not be interpreted as a precise estimate of the underlying population prevalence.

Methodological sensitivity analyses highlighted the instability inherent in rare-event meta-analytic modeling. The investigators retained an originally prespecified random-effects logit model using restricted maximum likelihood estimation and Hartung–Knapp–Sidik–Jonkman confidence intervals, alongside alternative continuity corrections and transformation-based methods. These continuity-corrected sensitivity models produced pooled prevalence estimates ranging between 1.62 percent and 2.23 percent, demonstrating pronounced numerical sensitivity to how zero-event cohorts are mathematically handled.

The study concluded that while persistent ventricular dysfunction appears rare at late follow-up, the available evidence remains insufficient to determine exact population prevalence with precision. The authors noted that clinical inference is further restricted by heterogeneous follow-up schedules across studies and potential selection bias resulting from nonuniform late imaging, emphasizing the need for larger prospective cohorts with standardized long-term surveillance.

Subject of Research: Prevalence of persistent left ventricular systolic dysfunction at six months or later after pediatric multisystem inflammatory syndrome

Article Title: Persistent left ventricular systolic dysfunction at ≥6 months after SARS-CoV-2–associated MIS-C: a systematic review and rare-event meta-analysis

Article References: Shafeen, K., Al Qahtani, M., Alnajjar, A., Alam, M., Gurumurthy, K., Masala, C. G., Al Othman, W., Al Essa, N. A., Almutiri, M., Esmail, A., Al Qannas, M., & Uddin, M. S. (2026). Persistent left ventricular systolic dysfunction at ≥6 months after SARS-CoV-2–associated MIS-C: a systematic review and rare-event meta-analysis. Frontiers in Cardiovascular Medicine, 13, Article 1931919. https://doi.org/10.3389/fcvm.2026.1931919

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1931919

Keywords: multisystem inflammatory syndrome in children, MIS-C, SARS-CoV-2, pediatric cardiology, left ventricular systolic dysfunction, echocardiography, systematic review, meta-analysis, Persistent, left, ventricular, systolic