Narrative review of paediatric cardiovascular sequelae after SARS-CoV-2, covering MIS-C, subclinical myocardial dysfunction (GLS, CMR), and autonomic dysfunction in children; literature search January 2020 – May 2026, minimum 4-week follow-up required for inclusion.
Overt cardiac dysfunction after MIS-C resolved in the vast majority of children across cohorts (e.g., 98.3% in a Krakow cohort; all but one patient in the MUSIC cohort by 6 months). However, persistent GLS impairment was reported in 13–35.7% of selected cohorts at 6–12 months, and residual LGE on CMR in up to 33% of smaller studies, though the large MUSIC CMR analysis found only 3.5% met Lake Louise criteria at follow-up. Autonomic dysfunction (including POTS in 62.5% of one small retrospective cohort) contributed to persistent symptoms when conventional cardiac evaluation was normal.
- Substantial heterogeneity in case definitions, follow-up timing, and diagnostic protocols prevents pooled estimates. - Most studies are single-centre with small samples; CMR and CPET often performed only in selected subgroups, introducing referral bias. - Long-term prognostic significance of isolated GLS or CMR abnormalities is unknown; no validated discharge criteria exist.
Reserve ongoing cardiology surveillance for children with persistent objective cardiac abnormalities (ventricular dysfunction, arrhythmia, coronary aneurysm, elevated biomarkers); asymptomatic children with normal ECG, echo, and biomarkers at 4–6 weeks can be discharged from routine follow-up. Children with palpitations, orthostatic symptoms, or fatigue but normal conventional cardiac studies should be redirected to autonomic evaluation and rehabilitation rather than escalating cardiac imaging.
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