Systemic Arterial Function after Multisystem Inflammatory Syndrome in Children Associated with COVID-19

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The paper is well-structured and written in a clear and concise manner. I noticed that some sections, particularly the methods and results, could benefit from additional detail to enhance reproducibility and transparency. 

 

Here are some comments upon my review ; 

- The authors should consider adding more visuals (e.g, figures of wave form  ) to illustrate key findings and enhance readability.

 

 

-I did not find the criteria of wave form . Suggest to provide more details on the criteria for "quality waveforms" to clarify the reliability of pulse wave velocity measurements.

-Could you also explain the choice of using both left ventricular ejection fraction and shortening fraction for assessing systolic function ?

-Additionally, I have also not found the baseline data on comorbidities and medications of the participants. Can you please also provide comorbidities and medications information  . 

 

Since the study aimed to conduct the association between transient systemic arterial dysfunction by pulse wave doppler and MIS-C, do you have any explanation about sensitivity analyses to test the robustness of the findings ? For example, exclude patients with severe comorbidities or those who received specific treatments to see if the results hold.

 

 

Author Response

We thank Reviewer # 1 for the comments. We believe that these have strengthened the paper.

Comment 1: The authors should consider adding more visuals (e.g, figures of wave form  ) to illustrate key findings and enhance readability

Response 1: We agree that visuals can be very helpful to illustrate key findings. However, the appearance of the pulse wave velocity waveform is essentially an arterial wave form that is similar to an arterial line waveform. We believe that adding a waveform in this instance would not be any further enlightening.

Comment 2: I did not find the criteria of wave form . Suggest to provide more details on the criteria for "quality waveforms" to clarify the reliability of pulse wave velocity measurements.

Response 2: We agree that 'quality waveform' is an ambiguous statement. We have provided additional clarification for the appearance of the waveform and the signal strengths that the machine provides.  Page 2, lines 84 - 86 is where the information is located. 

Comment 3: Could you also explain the choice of using both left ventricular ejection fraction and shortening fraction for assessing systolic function ? 

Response 3: In addition to left ventricular ejection fraction and shortening fraction, we used a third index of LV function, LV strain. The reason we chose multiple measurements to assess systolic function [and diastolic function] was to strengthen the results related to systolic function. We felt the elevated mean pulse wave velocity was also important in the setting of the predominantly normal echocardiographic measurements. 

Comment 4: Additionally, I have also not found the baseline data on comorbidities and medications of the participants. Can you please also provide comorbidities and medications information  

Response 4: We understand the importance of emphasizing that our sample was healthy children without serious comorbidities prior to hospitalization for MIS-C. On page 4, lines 171-176 the sample is now described in greater detail related to comorbidities and medications. 23 patients with no prior medical history, 3 patients with asthma, 1 each for anxiety and eczema. In general these are fairly mild co-morbidities that would not be expected to impact pulse wave velocity or cardiac function. Medications were also reviewed and provided in the new paragraph.

Comment 5: Since the study aimed to conduct the association between transient systemic arterial dysfunction by pulse wave doppler and MIS-C, do you have any explanation about sensitivity analyses to test the robustness of the findings ? For example, exclude patients with severe comorbidities or those who received specific treatments to see if the results hold

Response 5: As per the prior response, the sample was healthy children without severe comorbidities. After review with our statistical analyst, given the sample size and patient classification, we did not feel there were any patients who should be excluded. 

 

Reviewer 2 Report

Comments and Suggestions for Authors

Authors presented a study about systemic arterial function after multisystem inflammatory syndrome In children associated with COVID-19. Multisystem Inflammatory Syndrome in Children (MIS-C) is linked to COVID-19, it causes inflammation in the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal tract, among other regions of the body.

Please specify if it is an observational prospective/retrospective study. Is it a chohort study?Please better specify methods section.

I appreciate the paragraph about limitations.

The content is interesting. MIS-C is an uncommon yet dangerous illness t, effective management of this pathology requires early intervention as well as knowledge of the symptoms and risk factors. 

 

Author Response

We thank reviewer # 2 for the comments.

Comment 1: Please specify if it is an observational prospective/retrospective study. Is it a cohort study? Please better specify methods section

Response 1: Although retrospective was listed in the abstract, we did not identify the study design in methods section. On page 2, lines 67-69 are edited to inform the reader that retrospective observational data collection was performed.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your detailed feedback. The author has revised the manuscript and addressed all the questions and concerns you raised. We believe these revisions have significantly improved the quality of the manuscript despite there are some information still being needed  .