Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Abstract

BACKGROUND Since the beginning of the pandemic, coronavirus disease-2019 (COVID-19) in children has shown milder cases and a better prognosis than adults. Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults. AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency. METHODS Multiple searches in MEDLINE, PubMed were performed using the search terms “COVID-19” or “SARS-CoV-2" were used in combination with “myocardial injury” or "arrhythmia" or “cardiovascular involvement” or "heart disease" or "congenital heart disease" or “pulmonary hypertension” or "long QT" or “cardiomyopathies” or “channelopathies” or "Multisystem inflammatory system" or "PMIS" or “MIS-C” or ”Pediatric multisystem inflammatory syndrome" or "myocarditis" or "thromboembolism to identify articles published in English language from January 1st, 2020 until July 31st, 2020. The websites of World Health Organization, Centers for Disease control and Prevention, and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts concerning the subject were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19 (PMIS), multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients. RESULTS A total of 193 articles were included. Most publications used in this review were single case reports, small case series, and observational small-sized studies or literature reviews. The meta-analysis of 16 studies with size > 10 patients and with complete data about cardiovascular involvement in children with PMIS showed that PMIS affects mostly previously healthy school-aged children and adolescents presenting with Kawasaki disease-like features and multiple organ failure with a focus on the heart, accounting for most cases of pediatric COVID-19 mortality. They frequently presented cardiogenic shock (53%), ECG alterations (27%), myocardial dysfunction (52%), and coronary artery dilation (15%). Most cases required PICU admission (75%) and inotropic support (57%), with the rare need for extracorporeal membrane oxygenation (4%). Almost all of these children wholly recovered in a few days, although rare deaths have been reported (2%). Out of PMIS cases we ide...

Is Short-Term Exposure to PM2.5 Relevant to Childhood Kawasaki Disease?

“…Especially, since the beginning of the pandemic of coronavirus disease-2019 (COVID-19), a surge of SARS-Cov-2 patients with COVID-19 syndrome overlapping with KD, called multisystem inflammatory syndrome in children (MIS-C), has been reported in 2020 [28][29][30]. KD and MIS-C share several common symptoms, such as skin rash, lymphadenopathy, strawberry tongue, coronary artery dilatation and an elevation inflammatory biomarkers such as C-reactive protein, procalcitonin, ferritin [31]. Furthermore, several unique symptoms of MIS-C and KD are prevalent in children, and children have fewer pro-inflammatory cytokines secretion and more active innate immune response than adults [31].…”

“…KD and MIS-C share several common symptoms, such as skin rash, lymphadenopathy, strawberry tongue, coronary artery dilatation and an elevation inflammatory biomarkers such as C-reactive protein, procalcitonin, ferritin [31]. Furthermore, several unique symptoms of MIS-C and KD are prevalent in children, and children have fewer pro-inflammatory cytokines secretion and more active innate immune response than adults [31]. Therefore, understanding that the KD is rather not associated with PM 2.5 may provide us with new information regarding the pathogenesis of MIS-C in COVID-19, as well as the conserve.…”

Severe sinus bradycardia associated with remdesivir in a child with severe SARS-COV-2 infection—reply

“…Some small series have reported arrhythmias in up to 16% of children admitted with SARS-COV-2, almost all of them not treated with RDV. These arrhythmias were mild or less harmful than the ones reported in adults [6]. For these reasons, establishing RDV as the certain/probable cause of the reported bradycardia cannot be concluded.…”

“…However, a considerable number of patients presented with underlying cardiovascular diseases received concomitant medications and/or presented other comorbidities [2][3][4][5]. In addition, SARS-CoV-2 may directly cause myocardial damage by entering cardiomyocytes via the ACE2 receptor, due to cytokine storm, or as a result of hypoxemia [6].…”

Myopericarditis Associated with COVID-19 in a Pediatric Patient with Kidney Failure Receiving Hemodialysis

“…Myocarditis in our patient occurs as a pre-existing cardiovascular disease, in the context of kidney failure, left ventricular hypertrophy, and diastolic dysfunction. Troponin values can be elevated in patients with COVID-19 infection with CKD, and elevations of other cardiac biomarkers (NT-proBNP, D-dimer) will be more specific as indicators of cardiac injury [ 23 , 24 , 25 ]. Two months after COVID-19 infection was confirmed, our patient exhibited severe systolic and diastolic dysfunction of left ventricle (more severe than cardiac decompensation from the acute phase of COVID-19 infection) associated with severe pulmonary hypertension and mild right ventricle systolic dysfunction.…”