Figure 1. Conceptual model of potential etiologies of impaired cardiac function in MIS‐C.

Potential pathophysiology of left ventricular (LV) dysfunction in MIS‐C, arranged according to whether each etiology is expected to result in a global vs segmental pattern of myocardial dysfunction (decreased strain). Black arrows indicate associations directly tested in this study, including (1) acute stress cardiomyopathy, (2) cytokine release and composition, (3) clinical and laboratory markers of microangiopathy, and (4) severity of shock. The presence of coronary ischemia (gray arrow) was inferred from regional wall motion abnormalities. White arrows indicate other speculations that were beyond the scope and, therefore, not tested in this study. MIS‐C indicates multisystem inflammatory syndrome in children.