How safe are children with COVID-19 from cardiac risks? Pediatric risk assesment; insights from echocardiography and electrocardiography

Çevik, Berna Şaylan; Arici, Sule; Ergenç, Zeynep; Kepenekli, Eda; Günal, Özge; Yakut, Nurhayat

doi:10.3906/sag-2010-240

Cited by 3 publications

(1 citation statement)

References 35 publications

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“…The pathogenesis of the cardiac damage of COVID-19 is not clear in children. The reported causes of cardiac damage are increased cytokines and immune-inflammatory response, invasion of cardiomyocytes with SARS-CoV-2, lung failure, and hypoxia leading to oxidative stress and damage in cardiomyocytes [ 9 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

et al. 2022

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Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2–max. 144) months, which was statistically lower than the age of patients with normal troponin levels ( P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay ( P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels ( P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.

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Section: Discussionmentioning

confidence: 99%

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

et al. 2022

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Ventricular repolarization heterogeneity in patients with COVID‐19: Original data, systematic review, and meta‐analysis

Mahmoudi

Mollazadeh

Mansouri

et al. 2022

Clinical Cardiology

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Background Coronavirus disease‐2019 (COVID‐19) has been associated with an increased risk of acute cardiac events. However, the effect of COVID‐19 on repolarization heterogeneity is not yet established. In this study, we evaluated electrocardiogram (ECG) markers of repolarization heterogeneity in patients hospitalized with COVID‐19. In addition, we performed a systematic review and meta‐analysis of the published studies. Methods QT dispersion (QTd), the interval between T wave peak to T wave end (TpTe), TpTe/QT (with and without correction), QRS width, and the index of cardio‐electrophysiological balance (iCEB) were calculated in 101 hospitalized COVID‐19 patients and it was compared with 101 non‐COVID‐19 matched controls. A systematic review was performed in four databases and meta‐analysis was conducted using Stata software. Results Tp‐Te, TpTe/QT, QRS width, and iCEB were significantly increased in COVID‐19 patients compared with controls (TpTe = 82.89 vs. 75.33 ms (ms), p‐value = .005; TpTe/QT = 0.217 vs. 0.203 ms, p‐value = .026). After a meta‐analysis of 679 COVID‐19 cases and 526 controls from 9 studies, TpTe interval, TpTe/QT, and TpTe/QTc ratios were significantly increased in COVID‐19 patients. Meta‐regression analysis moderated by age, gender, diabetes mellitus, hypertension, and smoking reduced the heterogeneity. QTd showed no significant correlation with COVID‐19. Conclusion COVID‐19 adversely influences the ECG markers of transmural heterogeneity of repolarization. Studies evaluating the predictive value of these ECG markers are warranted to determine their clinical utility.

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Features of electrocardiogram in school-age children with COVID-19

Кожевникова

Абашидзе

Fisenko

et al. 2022

RPJ

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Introduction. Currently, there is an increase in the incidence and an increase in the severity of the course of COVID-19 in children. The tropism of the SARS-CoV-2 virus to the cardiovascular system has been established, while post-COVID syndrome with various manifestations is recorded in 25% of recovered adolescents. The purpose of the work was to identify the features of the electrocardiogram (ECG) pattern in children hospitalized with a diagnosis of COVID-19. Results. Significant changes in the conductivity and activity of the left heart myocardium were found in COVID-19 patients with pneumonia and respiratory failure. Pronounced changes in ECG indices were found in children of senior school age who were admitted for treatment 2.4 times more often than other children. Proarrhythmogenic ECG indices in children were detected in severe COVID-19 - with community-acquired pneumonia (ΔQTc, QTcmin) and respiratory failure (TpTe/QTmax). These ECG changes, combined with the trend in inflammation markers (an increase in the C-reactive protein level and a decrease in the number of lymphocytes) in children with a moderate course of COVID-19 may be a sign of the involvement of the myocardium in an infectious inflammatory process. This suggests that the effect on the myocardium is exerted by systemic inflammation and not by the hemodynamic overload of the right heart, which is expected in pulmonary pathology. Conclusion. The obtained data indicate the need for dynamic ECG monitoring during the acute stage of the disease and rehabilitation of children who suffered from COVID-19.

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How safe are children with COVID-19 from cardiac risks? Pediatric risk assesment; insights from echocardiography and electrocardiography

Cited by 3 publications

References 35 publications

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

Ventricular repolarization heterogeneity in patients with COVID‐19: Original data, systematic review, and meta‐analysis

Features of electrocardiogram in school-age children with COVID-19

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