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