Abstract 4367081: Electrocardiogram Abnormalities and Arrhythmias: Analysis of the NHLBI Study on Long-term Outcomes after the Multisystem Inflammatory Syndrome in Children (MUSIC)
Bibliographic record
Abstract
Background: Cardiac complications are common in the Multisystem Inflammatory Syndrome in Children (MIS-C); however, data on arrhythmias and other electrocardiogram (ECG) abnormalities are limited. Objective: To characterize the frequency of and risk factors for ECG abnormalities and arrhythmias in patients with MIS-C, and their associated outcomes. Methods: Secondary analysis of ECG and ambulatory monitor data from a 32-center cohort study of patients with MIS-C hospitalized between 03/2020 to 11/2021 with a follow-up period of 2 years. ECG and ambulatory monitor interpretation was performed at each participating site. Greater illness severity was defined as one or more of the following: vasoactive medications, cardiac dysfunction or elevated troponin, intubation or mechanical support. Results: From 1,204 patients in the MUSIC cohort, ECG data were available for 1,104 patients (92%). Overall, ECG was abnormal in 864 (78%) of patients (Figure), most frequently sinus tachycardia (37%), ST-T waves anomalies (30%), prolonged QTc interval (23%), sinus bradycardia (16%), and left ventricular hypertrophy (14%). Arrhythmias were reported in 71/952 (7%) patients with myocarditis and included atrioventricular block (AVB, n=22; 1 st degree in 14, Mobitz 1 in 1, Mobitz 2 or higher in 7), ventricular tachycardia (n=8), supraventricular tachycardia (n=5), junctional tachycardia (n=5) and isolated ectopy (n=5 atrial, n=6 ventricular). Risk factors for ECG abnormalities included older age, White or Hispanic/Latino ethnicity, elevated troponin, myocarditis or cardiac dysfunction, and pericarditis or pericardial effusion (Table). Risk factors for arrhythmias included older age, obesity, elevated troponin and myocarditis or cardiac dysfunction (Table). Patients with arrhythmias and other ECG abnormalities were more likely to have greater illness severity and prolonged length of stay. Ambulatory rhythm monitoring was performed in 156 patients (13%) at median 64 [IQR 22, 164] days after hospital discharge, with normal results in 140 (88%) patients. The most frequent abnormalities were AVB (n=8, 5%) and isolated ectopy (>100 beats/24 hours; n=6, 4%) , with no high-grade AVB or tachyarrhythmias identified. Conclusion: ECG anomalies are frequent in MIS-C and associated with myocarditis, greater illness severity and prolonged hospital length of stay. Arrhythmias and other ECG abnormalities mostly occurred during acute hospitalization, and were very uncommon during outpatient follow-up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".