{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:38:15Z","timestamp":1781325495320,"version":"3.54.1"},"reference-count":58,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,14]],"date-time":"2023-12-14T00:00:00Z","timestamp":1702512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2014NextGenerationEU through the National Recovery and Resilience Plan of the Republic of Bulgaria","award":["BG-RRP-2.004-0008"],"award-info":[{"award-number":["BG-RRP-2.004-0008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Multisystem inflammatory syndrome in children (MIS-C) poses challenges to the healthcare system, especially with frequent heart involvement. The current retrospective observational study aims to summarize the type and degree of cardiovascular involvement in children with MISC and to find possible associations between laboratory, inflammatory, and imaging abnormalities and the predominant clinical phenotype using a cluster analysis. Material and methods: We present a retrospective observational single-center study including 51 children meeting the MIS-C criteria. Results: Fifty-three percent of subjects presented with at least one sign of cardiovascular involvement (i.e., arterial hypotension, heart failure, pericardial effusion, myocardial dysfunction, pericarditis without effusion, myocarditis, coronaritis, palpitations, and ECG abnormalities). Acute pericarditis was found in 30\/41 of the children (73%) assessed using imaging: 14\/30 (46.7%) with small pericardial effusion and 16\/30 (53.3%) without pericardial effusion. The levels of CRP were significantly elevated in the children with pericarditis (21.6 \u00b1 13 mg\/dL vs. 13.9 \u00b1 11 mg\/dL, p = 0.035), and the serum levels of IL-6 were higher in the children with small pericardial effusion compared to those without (191 \u00b1 53 ng\/L vs. 88 \u00b1 27 ng\/L, p = 0.041). Pericarditis with detectable pericardial effusion was significantly more frequent in the female vs. male subjects, 72% vs. 30% (p = 0.007). The hierarchical clustering analysis showed two clusters: Cluster 1 includes the children without cardiovascular symptoms, and Cluster 2 generalizes the MIS-C children with mild and severe cardiovascular involvement, combining pericarditis, myocarditis, heart failure, and low blood pressure. Also, subjects from Cluster 2 displayed significantly elevated levels of fibrinogen (5.7 \u00b1 0.3 vs. 4.6 \u00b1 0.3, p = 0.03) and IL-6 (158 \u00b1 36 ng\/mL vs. 66 \u00b1 22 ng\/mL, p = 0.032), inflammatory markers suggestive of a cytokine storm. Conclusions: Our results confirm that children with oligosymptomatic MIS-C or those suspected of long COVID-19 should be screened for possible cardiological involvement.<\/jats:p>","DOI":"10.3390\/medicina59122175","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T03:16:33Z","timestamp":1702610193000},"page":"2175","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Bulgarian Study"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4666-0181","authenticated-orcid":false,"given":"Niya","family":"Mileva","sequence":"first","affiliation":[{"name":"Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6314-6889","authenticated-orcid":false,"given":"Georgi H.","family":"Vasilev","sequence":"additional","affiliation":[{"name":"Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, \u201cPlovdivsko pole\u201d Str. No. 6, 1756 Sofia, Bulgaria"},{"name":"Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borislav","family":"Ganev","sequence":"additional","affiliation":[{"name":"Pediatric Department, University Hospital N. I. Pirogov, 21 General Eduard I. Totleben blvd, 1606 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8380-5992","authenticated-orcid":false,"given":"Lyubomir","family":"Chervenkov","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria"},{"name":"Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hristiana","family":"Batselova","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Disaster Medicine, Medical University of Plovdiv, University Hospital \u201cSt George\u201d, blvd. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iren","family":"Tzotcheva","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, UMHATEM \u201cN. I. Pirogov\u201d, Blvd. \u201cGeneral Eduard I. Totleben\u201d 21, Pette Kyosheta, 1606 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-6473","authenticated-orcid":false,"given":"Latchezar","family":"Tomov","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria"},{"name":"Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0593-1272","authenticated-orcid":false,"given":"Tsvetelina","family":"Velikova","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snezhina","family":"Lazova","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria"},{"name":"Pediatric Clinic, UMHATEM \u201cN. I. Pirogov\u201d, Blvd. \u201cGeneral Eduard I. Totleben\u201d 21, Pette Kyosheta, 1606 Sofia, Bulgaria"},{"name":"Department of Healthcare, Faculty of Public Health \u201cProf. Tsekomir Vodenicharov, MD, DSc\u201d, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJMe2023158","article-title":"Childhood Multisystem Inflammatory Syndrome\u2014A New Challenge in the Pandemic","volume":"383","author":"Levin","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMoa2021756","article-title":"Multisystem Inflammatory Syndrome in Children in New York State","volume":"383","author":"Dufort","year":"2020","journal-title":"N. Engl. J. 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