Covid-associated Multisystem Inflammatory Syndrome in Children and Cardiovascular Autonomic Control: a Prospective Cohort Study Nine Months after SARS-CoV-2 Infection. DATASET

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Abstract

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) has emerged as a severe pediatric complication during the SARS-CoV-2 pandemic, with potential long-term cardiovascular repercussions. We hypothesized that heart rate and blood pressure control at rest and during postural maneuvers in MIS-C patients months after the remission of the inflammatory syndrome may reveal long-term autonomic dysfunctions. Methods: We assessed 17 MIS-C patients (13 males; 11.9±2.6 years, m±SD) 9 months after acute infection and 18 age- (12.5±2.1 years) and sex- (13 males) matched controls. Heart rate and blood pressure variability, baroreflex function, and hemodynamic parameters were analyzed in supine and standing postures. Results: MIS-C patients exhibited reduced heart rate variability, particularly in parasympathetic parameters (pNN50 and RMSSD; p<0.05 between groups), compared to controls both at rest and during standing, with no interaction between case and posture. Blood pressure variability and baroreflex sensitivity did not differ between groups except for the high-frequency power in systolic blood pressure (p=0.01 between groups). The MIS-C group also showed lower diastolic and systolic pressure-time indices. Conclusions: Altered cardiovascular autonomic control may persist in MIS-C patients with, however, compensatory mechanisms that may help maintain cardiovascular homeostasis during light autonomic challenges, as postural maneuvers. These results highlight the importance of assessing long-term cardiovascular autonomic control in children with MIS-C to possibly identify residual cardiovascular risks and inform targeted interventions and rehabilitation protocols.