Cardiovascular magnetic resonance findings in non‐hospitalized paediatric patients after recovery from COVID‐19

Abstract

Aims Our study aimed to investigate the cardiac involvement with sensitive tissue characterization in non‐hospitalized children with coronavirus disease 2019 (COVID‐19) infection using cardiovascular magnetic resonance (CMR) imaging. Methods and results We prospectively enrolled children who recovered from mildly symptomatic COVID‐19 infection between November 2020 and January 2021. Patients underwent CMR at 1.5 T (Achieva, Philips Healthcare, Best, the Netherlands) including cine images, native T1 and T2 mapping. Healthy children and paediatric patients with biopsy‐proven myocarditis served as control groups. We performed CMR in 18 children with a median (25th–75th percentile) age of 12 (10–15) years, 38 (24–47) days after positive PCR test, and compared them with 7 healthy controls [15 (10–19) years] and 9 patients with myocarditis [10 (4–16) years]. The COVID‐19 patients reported no cardiac symptoms. None of the COVID‐19 patients showed CMR findings consistent with a myocarditis. Three patients (17%) from the COVID‐19 cohort presented with minimal pericardial effusion. CMR parameters of COVID‐19 patients, including volumetric and strain values as well as T1 and T2 times, were not significantly different from healthy controls, but from myocarditis patients. These had significantly reduced left ventricular (LV) ejection fraction ( P = 0.035), LV global longitudinal strain, and left atrial strain values as well as elevated native T1 values compared with COVID‐19 patients ( P < 0.001, respectively). Conclusions There was no evidence of myocardial inflammation, fibrosis, or functional cardiac impairment in the studied cohort of children recently. CMR findings were comparable with those of healthy controls. Pericardial effusion suggests a mild pericarditis in a small subgroup. This is pointing to a minor clinical relevance of myocardial involvement in children after mildly symptomatic COVID‐19 infections.

The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

“…The included studies used CMR, ECG, and echocardiography to evaluate cardiac structure and function. Except for 7 studies, 17,20,23,24,27,36,39 the remaining 14 studies were enrolled in COVID‐19 patients from the first wave of the pandemic. COVID‐19 patients with any history of relevant cardiovascular diseases were excluded in 14 studies, 20,21,23,24,26–29,31,35,39–41 while the remaining studies included risk factor‐matched controls.…”

“…A total of 19 studies involving 2333 individuals (1313 post‐COVID‐19 cases and 1020 controls) reported LV EF in COVID‐19 survivors after recovery 13,17,18,20–22,24,26,28–31,34,35,37–41 . Overall pooled analyses showed reduced LV EF in recovered COVID‐19 patients (SMD = −0.18, 95% CI = −0.34 to −0.01, p = 0.04; Figure 2A).…”

“…COVID-19 patients with any history of relevant cardiovascular diseases were excluded in 14 studies, 20,21,23,24,[26][27][28][29]31,35,[39][40][41] while the remaining studies included risk factor-matched controls.…”

CMR findings after COVID-19 and after COVID-19-vaccination—same but different?

“…A study by Chen et al in 25 acute hospitalized COVID-19 patients found myocardial edema in 14 and myocardial damage in one patient [ 12 ]. A study in 18 asymptomatic pediatric patients after mild COVID-19 found no apparent cardiac involvement by CMR [ 26 ].…”

COVID-19 Infections in Adults with Congenital Heart Disease—A Prospective Single-Center Study in an Outpatient Setting

“…This could be attributed to the fact that our ACHD patients with COVID-19 infection were younger and had only mild or no symptoms. In accordance, a study of children who recently recovered from mildly symptomatic COVID-19 infections showed no evidence of myocardial inflammation, fibrosis, or functional cardiac impairment on CMR [ 27 ]. Furthermore, the rate in young athletes was also lower than those previously reported in an older population [ 28 ].…”