Significant exercise limitations after recovery from MIS-C related myocarditis

Gur Mainzer, Merav Zucker-Toledano, Moneera Hanna, Ronen Bar-Yoseph, Einat Kodesh

Research output: Contribution to journalArticlepeer-review


Background: Myocarditis is one of the presentations of multisystemic inflammatory syndrome in children (MIS-C) following coronavirus disease 2019 (COVID-19). Although the reported short-term prognosis is good, data regarding medium-term functional capacity and limitations are scarce. This study aimed to evaluate exercise capacity as well as possible cardiac and respiratory limitations in children recovered from MIS-C related myocarditis. Methods: Fourteen patients who recovered from MIS-C related myocarditis underwent spirometry and cardiopulmonary exercise testing (CPET), and their results were compared with an age-, sex-, weight- and activity level-matched healthy control group (n = 14). Results: All participants completed the CPET with peak oxygen uptake (peak V. O 2), and the results were within the normal range (MIS-C 89.3% ± 8.9% and Control 87.9% ± 13.7% predicted V. O 2). Five post-MIS-C patients (35%) had exercise-related cardio-respiratory abnormalities, including oxygen desaturation and oxygen-pulse flattening, compared to none in the control group. The MIS-C group also had lower peak exercise saturation (95.6 ± 3.5 vs. 97.6 ± 1.1) and lower breathing reserve (17.4% ± 7.5% vs. 27.4% ± 14.0% of MVV). Conclusions: Patients who recovered from MIS-C related myocarditis may present exercise limitations. Functional assessment (e.g., CPET) should be included in routine examinations before allowing a return to physical activity in post-MIS-C myocarditis. Larger, longer term studies assessing functional capacity and focusing on physiological mechanisms are needed.

Original languageEnglish
Number of pages6
JournalWorld Journal of Pediatrics
Early online date1 May 2023
StateE-pub ahead of print - 1 May 2023

Bibliographical note

Publisher Copyright:
© 2023, Children's Hospital, Zhejiang University School of Medicine.


  • Cardiopulmonary exercise testing
  • COVID 19
  • Hypoxemia
  • Myocarditis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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