Cardiac involvement in a pediatric patient with COVID‐19: Looking beyond the nonspecific global cardiac injury

Bhansali, Suneet; Minocha, Prashant; Phoon, Colin K.L.; Henry, Gillian; Chakravarti, Sujata; Ramírez, Michelle; Bhatla, Puneet

doi:10.1111/echo.14814

Cited by 6 publications

(7 citation statements)

References 9 publications

(20 reference statements)

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“…Fever was documented in nearly all patients (922/928; 99.4%) [ 11 – 17 , 23 , 24 , 30 – 85 ], commonly during at least 5 days (258/928; 27.0%). The majority (598/699; 85.6%) presented gastrointestinal symptoms, mostly abdominal pain (315/539; 58.4%), vomiting (306/532; 57.5%), and diarrhea (268/532; 50.4%) [ 11 – 14 , 16 , 24 , 26 , 30 – 37 , 39 , 40 , 43 – 45 , 47 , 49 – 52 , 54 – 77 , 79 , 80 , 82 , 84 – 86 ]. Cardiovascular manifestations were found in 79.3% of patients (307/387) [ 11 – 17 , 24 , 30 – 37 , 39 – 41 , 44 – 49 , 51 – 86 ].…”

Section: Resultsmentioning

confidence: 99%

“…Besides inflammatory parameters, coagulation markers were substantially upregulated, including d -dimers (3750 ng/ml [1946–6896]) and fibrinogen (640 mg/dl [504–800]) [ 11 , 12 , 31 – 35 , 38 , 40 , 43 – 47 , 49 , 51 , 55 – 57 , 60 , 62 , 66 – 68 , 70 , 71 , 75 – 77 , 80 , 84 ]. Furthermore, myocardial injury markers such as troponins (188 ng/l [60–614]) and brain natriuretic peptide (BNP) (median 1619 pg/ml [424–3325]) were often elevated [ 11 , 12 , 30 , 32 – 36 , 39 , 40 , 46 – 49 , 54 – 57 , 60 , 62 , 66 – 71 , 75 , 77 , 80 , 84 , 87 , 88 ]. Hyponatremia (130 mmol/l [128–133]) [ 12 , 24 , 30 , 32 , 35 , 37 , 41 , 44 – 46 , 48 – 50 , 52 , 54 , 55 , 62 , 67 , 69 , 76 , 84 ] was frequent, contrasting with KD controls (135 mmol/l [134–137]) [ 64 ] or non-PIMS-TS/MIS(-C) COVID-19 (137 mmo...…”

Section: Resultsmentioning

confidence: 99%

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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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An association between a novel pediatric hyperinflammatory condition and SARS-CoV-2 was recently published and termed pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS(-C)). We performed a systematic review and describe the epidemiological, clinical, and prognostic characteristics of 953 PIMS-TS/MIS(-C) cases in 68 records. Additionally, we studied the sensitivity of different case definitions that are currently applied. PIMS-TS/MIS(-C) presents at a median age of 8 years. Epidemiological enrichment for males (58.9%) and ethnic minorities (37.0% Black) is present. Apart from obesity (25.3%), comorbidities are rare. PIMS-TS/MIS(-C) is characterized by fever (99.4%), gastrointestinal (85.6%) and cardiocirculatory manifestations (79.3%), and increased inflammatory biomarkers. Nevertheless, 50.3% present respiratory symptoms as well. Over half of patients (56.3%) present with shock. The majority of the patients (73.3%) need intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%. Despite severe disease, mortality is rather low (1.9%). Of the currently used case definitions, the WHO definition is preferred, as it is more precise, while encompassing most cases. Conclusion : PIMS-TS/MIS(-C) is a severe, heterogeneous disease with epidemiological enrichment for males, adolescents, and racial and ethnic minorities. However, mortality rate is low and short-term outcome favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial. What is Known: • A novel pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2. • To date, the scattered reporting of cases and use of different case definitions provides insufficient insight in the full clinical spectrum, epidemiological and immunological features, and prognosis. What is New: • This systematic review illustrates the heterogeneous spectrum of PIMS-TS/MIS(-C) and its epidemiological enrichment for males, adolescents, and racial and ethnic minorities. • Despite its severe presentation, overall short-term outcome is good. • The WHO MIS definition is preferred, as it is more precise, while encompassing most cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-021-03993-5.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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“…Case reports and small series have described cardiogenic shock, myocarditis, pericarditis, and arrhythmias. [67][68][69][70] Arrhythmias have included ventricular tachycardia and atrial tachycardia, as well as first-degree atrioventricular block. 15,71…”

Section: Clinical Presentation Acute Sars-cov-2 Infectionmentioning

confidence: 99%

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

Jone¹,

John²,

Oster³

et al. 2022

Circulation

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Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.

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“…[ 1 2 3 4 5 6 ] In pediatric patients, cardiac injury may manifest both in acute COVID-19 infection and in the multisystem inflammatory syndrome in children (MIS-C). [ 7 8 9 10 11 12 13 14 ] The pathophysiology and mechanism of cardiac injury in these two conditions are distinctly different. The etiology of cardiac injury in the setting of acute COVID-19 has been thought to be a combination of direct viral infection and local vascular disease in the setting of certain modifiable and nonmodifiable risk factors and/or multi-organ injury secondary to acute respiratory distress syndrome (ARDS).…”

Section: Introductionmentioning

confidence: 99%

Strain in children with MIS-C and acute COVID-19

Bhatla¹,

Minocha²,

Srinivasan³

et al. 2022

Ann Pediatr Card

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Context: Cardiac injury has been described in both acute COVID-19 and the multisystem inflammatory syndrome in children (MIS-C). Echocardiographic strain has been shown to be a sensitive measure of systolic function. Aims: We sought to describe strain findings in both the groups on initial presentation and follow-up. Settings and Design: A retrospective study analyzing echocardiograms of all patients presenting with acute COVID-19 infection and MIS-C at our institution between March 2020 and December 2020 was performed. Subjects and Methods: TOMTEC software was used for strain analysis in both the study groups (COVID-19 and MIS-C) and age-matched healthy controls. Strain was correlated with LV ejection fraction (EF) and serum troponin levels. Results: Forty-five patients (34 – MIS-C and 11 – COVID-19) met the inclusion criteria. There was a statistically significant decrease in LV longitudinal strain ( P < 0.001), LV circumferential strain ( P < 0.001), and left atrial strain ( P = 0.014) in the MIS-C group when compared to the control group. There was a statistically significant decrease in LV longitudinal strain ( P = 0.028) in the acute COVID-19 group. All patients with abnormal left ventricular EF (LVEF) had abnormal strain. However, 14 (41%) patients in the MIS-C group and 3 (27%) in the acute COVID-19 group had preserved LVEF but abnormal strain. There was a significant correlation with LV longitudinal strain ( P = 0.005) and LVEF ( P = 0.002) and troponin in patients with MIS-C. Abnormal strain persisted in one-third of patients in the MIS-C and acute COVID-19 groups on outpatient follow-up. Conclusions: Patients with MIS-C and acute COVID-19 can develop myocardial dysfunction as seen by abnormal strain. LV longitudinal strain correlates with cardiac injury as measured by serum troponin in patients with MIS-C. Strain may provide an additional tool in detecting subtle myocardial dysfunction. It can be routinely employed at diagnosis and at follow-up evaluation of these patients.

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Cardiac involvement in a pediatric patient with COVID‐19: Looking beyond the nonspecific global cardiac injury

Cited by 6 publications

References 9 publications

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

Strain in children with MIS-C and acute COVID-19

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