Cardiac alterations associated with multisystem inflammatory syndrome in children related to COVID-19: a cross-sectional study from the Colombian Caribbean.

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition that follows SARS-CoV-2 infection, characterized by persistent fever and multi-organ dysfunction. Cardiac involvement occurs in 67%-80% of cases, representing a critical clinical concern. Data from tropical and Caribbean regions remain limited in the global MIS-C literature. We conducted a cross-sectional study with retrospective data collection at Hospital Infantil Napoleón Franco Pareja, Colombia. Included patients were <18 years with a MIS-C diagnosis per WHO/CDC/RCPCH criteria and positive SARS-CoV-2 serology. Cardiac involvement was defined by elevated troponin, abnormal echocardiography, or electrocardiogram changes. Among n = 105 patients (median age 5 years, 61% male), cardiac involvement occurred in 25.7% (n = 27). The median number of affected organ systems was 4 (IQR: 3-4). Coronary artery dilation was the predominant cardiac finding (37.0% of cardiac cases), followed by mitral regurgitation and elevated troponin (both 33.3%). No patients showed left ventricular ejection fraction <55%. Treatment included corticosteroids (92.4%), acetylsalicylic acid (91.4%), and immunoglobulin (70.5%). All patients survived to discharge (100% survival). One-month follow-up revealed persistent coronary dilation in 2.9%. MIS-C affects multiple organ systems with coronary artery dilation as the predominant cardiac manifestation in our population. Favorable acute outcomes were observed with the current management protocols, including 100% survival and brief hospitalizations. However, persistent cardiac abnormalities in a subset of patients emphasize the need for systematic cardiac surveillance. These findings from a tropical Caribbean population provide insights applicable to resource-limited settings in other low- and middle-income countries.