Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents

Abstract

Background: In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported. Materials and Methods: A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed. Results: Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer ( P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy ( P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms. Conclusions: With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period.

Cardiac involvement in multisystem inflammatory syndrome in children: single-centre experience

“…38 Only one study evaluated the 24-hour Holter monitoring in the short-term follow-up of multisystem inflammatory syndrome in children patients, and the Holter records of all patients were normal. 39 However, in our study, Holter recordings were performed in the acute period and their relationship with the systolic function was also evaluated. Since Holter monitoring is not routinely performed, the incidence of arrhythmia in multisystem inflammatory syndrome in children may be underestimated.…”

Natural Course of COVID-19 and Independent Predictors of Mortality

“…The cardiovascular system appears to be directly affected by numerous interactions with SARS-CoV-2, as suggested by the evidence of myocardial damage in children [ 5 , 6 ] and adult patients [ 7 ]. Several studies have investigated the possible correlation between cardiac biomarkers and the severity of COVID-19 disease [ 8 , 9 , 10 ] in order to identify one or more cut-off values to stratify patients for disease severity.…”

Comparison of the effect of 40 and 80 mg/day doses of atorvastatin on changes in lipid profiles among acute coronary syndrome patients: A randomized clinical trial study

“…[ 1 ] However, this is not the only factor and other factors could induce the myocardial injuries. [ 2 3 ] Asian populations have a distinct pattern of dyslipidemia, which includes high levels of triglycerides (TGs), cholesterol, low-density lipoprotein (LDL), and low levels of high-density lipoprotein (HDL). [ 4 ] Evidence has been shown that statins are effective in preventing ACS.…”