Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

Authors

Ashraf S. Harahsheh, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Anita Krishnan, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Roberta L. DeBiasi, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Laura J. Olivieri, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Christopher Spurney, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Mary T. Donofrio, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Russell R. Cross, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Matthew P. Sharron, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Lowell H. Frank, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Charles I. Berul, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Adam Christopher, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Niti Dham, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Hemalatha Srinivasalu, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Tova Ronis, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Karen L. Smith, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Jaclyn N. Kline, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Kavita Parikh, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
David Wessel, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
James E. Bost, Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Sarah Litt, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Ashley Austin, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Jing Zhang, Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Craig A. Sable, Division of Cardiology, Children's National Hospital, Washington, DC, USA.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

Cardiology in the young

Volume

32

Issue

5

DOI

10.1017/S1047951121003024

Keywords

2019 coronavirus disease pandemic; Paediatric multisystem inflammatory syndrome temporally associated with 2019 coronavirus disease; coronary artery; multi-system inflammatory syndrome in children; myocarditis; paediatric cardiology

Abstract

BACKGROUND: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. OBJECTIVES: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. METHODS: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum. RESULTS: Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). CONCLUSION: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

APA Citation

Harahsheh, Ashraf S.; Krishnan, Anita; DeBiasi, Roberta L.; Olivieri, Laura J.; Spurney, Christopher; Donofrio, Mary T.; Cross, Russell R.; Sharron, Matthew P.; Frank, Lowell H.; Berul, Charles I.; Christopher, Adam; Dham, Niti; Srinivasalu, Hemalatha; Ronis, Tova; Smith, Karen L.; Kline, Jaclyn N.; Parikh, Kavita; Wessel, David; Bost, James E.; Litt, Sarah; Austin, Ashley; Zhang, Jing; and Sable, Craig A., "Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children" (2022). GW Authored Works. Paper 1016.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1016

Department

Pediatrics