Table 4.

Proposed recommendations for clinical follow-up of PIMS-TS patients post-discharge.

	Time since hospital discharge
Initial cardiac involvement (at diagnosis or during hospitalization)	1–2 weeks	4–6 weeks	3 months	6 months	12 months	Exercise restrictiona	General notes
(1) No cardiac involvement	Echo, ECG, BP Consider 24 h-ECGb Labsc ASS	Echo, ECG, BP Consider 24 h-ECGb Labsc ASS = > consider stopping if no coronary artery abnormalities	Consider stopping follow-up at 4–6 weeks in patients without Kawasaki-like presentation; If coronary abnormalities at any time during follow-up = > follow AHA KD guidelines 2017 [see (5) below]			2 weeks	Consider involvement of other specialities if initial and/or persistent organ system abnormalities No live vaccines for 11 months following high-dose IVIG (2 g/kg)
(2) Myocardial injury (elevated cTnc ± NT-pro-BNP), normal ventricular function and normal coronary arteries or (3) Myocardial injury with initially depressed ventricular function, normalized systolic function at hospital discharge (diastolic dysfunction may persist)	Echo, ECG, BP Consider 24 h-ECGb Labsc ASS	Echo, ECG, BP Consider 24-h-ECGb Labsc ASS = > consider stopping if no coronary abnormalities	Echo, ECG, BP 24 h-ECGa Exercise stress testa (Labsc) Consider cardiac MRId	Echo, ECG, BP Consider 24 h-ECGb (Labsc)	Echo, ECG, BP Consider 24 h-ECGb (Labsc)	3–6 months
(4) Myocardial injury with persistent depressed ventricular function at hospital discharge	Echo, ECG, BP Consider 24 h-ECGb Labsc ASS	Echo, ECG, BP Consider 24 h-ECGb Labsc ASS = > consider stopping if no coronary abnormalities	Follow-up and sport restriction should be tailored based on the severity of the cardiac involvement and in line with guidelines for heart failure and myocarditis in children.
(5) Coronary artery involvement	In addition to recommendations (1)–(4) above AHA guidelines 2017 should be respected with regards to follow-up, antiplatelet therapy/anticoagulation and exercise restriction.

ASS, acetylsalicylic acid; BP, blood pressure; CRP, C-reactive protein; Echo, echocardiography.

^a24 h-ECG and exercise stress test should be performed before returning to sports activity.

^bConsider 24 h-ECG if symptoms of arrythmia or abnormal ECG.

^cLaboratory investigations should include FBC, inflammatory markers (CRP) and cardiac enzymes (CK, CK-MB, cTnC, NT-pro-BNP) as well as other values not normalized at hospital discharge (such as coagulation, U/E, LFTs). Also consider performing urine testing if previously abnormal or signs of renal abnormalities.

^dMRI is considered in older patients without need for general anesthesia at 2–6 months post-discharge.