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Anagnostopoulou A, Dourdouna MM, Loukopoulou S, Mpourazani E, Poulakis M, Karanasios E, Michos A. Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography. Pediatr Cardiol 2024; 45:1110-1119. [PMID: 38372778 PMCID: PMC11056331 DOI: 10.1007/s00246-023-03375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/05/2023] [Indexed: 02/20/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C), is a rare but severe, hyperinflammatory complication of COVID-19, in which cardiovascular abnormalities are frequently detected. In this prospective study, we describe the echocardiographic findings in patients with MIS-C, with the use of conventional Echocardiography and Speckle-Tracking Echocardiography (STE) with Left Ventricular (LV) Global Longitudinal Strain (GLS) analysis, in the acute and follow-up phase. In total, 25 MIS-C patients [64% females, mean (± SD) age: 8.3 (± 3.72) years] were included. In the acute phase, median (IQR) Troponin and NT-proBNP and mean heart rate, were 8.07 (14.52) pg/mL, 2875.00 (7713.00) pg/mL, and 102.87 (± 22.96) bpm, respectively. Median (IQR) LV Ejection Fraction (LVEF) was 66 (8)% and LVEF impairment was detected in 2/25 (8%) patients. On follow-up (mean time interval:9.50 ± 4.59 months), heart rate was significantly lower, with a mean value of 90.00 (± 14.56) bpm (p-value = 0.017). Median (IQR) LVEF was 66.00 (6.70)% (p-value = 0.345) and all 25 participants had normal LVEF. In 14/25 patients, additional LV-GLS analysis was performed. During the acute phase, mean LV-GLS was - 18.02 (± 4.40)%. LV-GLS was abnormal in 6/14 patients (42.9%) and among them, only one patient had reduced LVEF. On follow-up (median (IQR) time interval:6.93 (3.66) months), mean LV-GLS was -20.31 (± 1.91)% (p-value = 0.07) and in 1/14 patient (7.1%), the LV-GLS impairment persisted. In conclusion, in the acute and follow-up phase, we detected abnormal LV-GLS values in some patients, in the presence of normal LVEF, indicating that STE-GLS is a valuable tool for identifying subclinical myocardial injury in MIS-C.
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Affiliation(s)
| | - Maria-Myrto Dourdouna
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece
| | - Sofia Loukopoulou
- Department of Pediatric Cardiology, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece
| | - Evdoxia Mpourazani
- Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece
| | - Marios Poulakis
- Department of Pediatric Cardiology, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece
| | - Evangelos Karanasios
- Department of Pediatric Cardiology, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece
| | - Athanasios Michos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, 11527, Greece.
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Maggio MC, Lembo A, Finazzo F, Alaimo A, Benfratello GF, Corsello G. Cardiovascular involvement in children with COVID-19 temporally related multisystem inflammatory syndrome (MIS-C): can cardiac magnetic resonance arrive to the heart of the problem? Ital J Pediatr 2024; 50:91. [PMID: 38702753 PMCID: PMC11071142 DOI: 10.1186/s13052-024-01658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) shows a significant overlap of symptoms with other hyper-inflammatory diseases such as Kawasaki disease (KD), but the real difference of the two conditions is still matter of debate. Coronary artery lesions (CAL) are the most relevant complication in KD. Nonetheless, CAL, myocarditis, pericarditis, arrhythmia are the main cardiovascular complications in MIS-C. A close clinical assessment is mandatory, both at the diagnosis and during the follow-up, by ECG and echocardiography. Cardiac magnetic resonance (MRI) adds important data to ultrasound findings. However, cardiac MRI studies in MIS-C are limited to a small number of cohorts. METHODS We enrolled 20 children (age:1-16 years; 11 F; 9 M) with cardiac involvement secondary to MIS-C, all evaluated by cardiac MRI. RESULTS 8 children showed pathological cardiac MRI: 2 showed pericardial effusion; 2 showed myocardial oedema; 1 showed aortic insufficiency; 3 showed delayed enhancement (one for acute myocarditis with oedema; 2 for myocardial fibrosis). Delayed enhancement was reduced significantly 5.6-9 months after the first MRI evaluation. 25% of patients with pathological MRI had CAL associated with valvular insufficiency of 2 valves. 17% of patients with normal MRI had CAL, associated with valvular insufficiency of 1 valve in 1 patient. The correlations between haematological, clinical, cardiologic parameters, treatment, did not reach the statistical significance. 4 patients were treated with anakinra. Among those, 2 patients showed a normal cardiac MRI. Cardiac lesions resolved in all the patients during the follow-up. Some patients with pathological cardiac MRI could not underwent a control with MRI, for the low compliance. However, echocardiography and ECG, documented the resolution of the pathological data in these cases. CONCLUSIONS A higher risk of CAL was documented in patients with an association of other cardiac lesions. Cardiac MRI is difficult to perform routinely; however, it is useful for evaluating the acute myocardial damage and the outcome of patients with MIS-C.
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Affiliation(s)
- Maria Cristina Maggio
- University Department PROMISE "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90100, Palermo, Italy.
| | - Alessio Lembo
- University Department PROMISE "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90100, Palermo, Italy
| | - Francesca Finazzo
- U.O.C. of Paediatric Radiology, Children Hospital "G. Di Cristina", ARNAS, Palermo, Via dei Benedettini 1, 90100, Palermo, Italy
| | - Annalisa Alaimo
- U.O.C. of Paediatric Cardiac Surgery, ARNAS, Palermo, Via dei Benedettini 1, 90100, Palermo, Italy
| | | | - Giovanni Corsello
- University Department PROMISE "G. D'Alessandro", University of Palermo, Via del Vespro 129, 90100, Palermo, Italy
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Giampetruzzi S, Sirico D, Mainini N, Meneghelli M, Valerio E, Salvadori S, Di Salvo G. Neonatal Enterovirus-Associated Myocarditis in Dizygotic Twins: Myocardial Longitudinal Strain Pattern Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:506. [PMID: 38790501 PMCID: PMC11120217 DOI: 10.3390/children11050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Enteroviruses (EVs) are the most common causes of viral myocarditis in neonates. Neonatal enterovirus myocarditis manifestations range from nonspecific febrile illness to congestive heart failure and cardiogenic shock with high risk of in-hospital mortality and long-term cardiac sequelae. Early recognition is essential to undertake appropriate therapy and predict outcomes. Echocardiography and echo-derived left ventricular strain measures seem promising for these purposes. We herein report two cases of neonatal enterovirus-associated myocarditis in dichorionic diamniotic twins, with different presentation, clinical course, and intensity of treatments.
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Affiliation(s)
- Stefania Giampetruzzi
- Neonatal Intensive Care Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy; (S.G.); (N.M.); (M.M.); (E.V.); (S.S.)
| | - Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy;
| | - Nicoletta Mainini
- Neonatal Intensive Care Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy; (S.G.); (N.M.); (M.M.); (E.V.); (S.S.)
| | - Marta Meneghelli
- Neonatal Intensive Care Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy; (S.G.); (N.M.); (M.M.); (E.V.); (S.S.)
| | - Enrico Valerio
- Neonatal Intensive Care Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy; (S.G.); (N.M.); (M.M.); (E.V.); (S.S.)
| | - Sabrina Salvadori
- Neonatal Intensive Care Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy; (S.G.); (N.M.); (M.M.); (E.V.); (S.S.)
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children Health, University of Padua, 35128 Padua, Italy;
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Netea SA, Biesbroek G, Groenink M, Planken RNN, de Winter RJ, Blom NA, Kuijpers TW, Kuipers IM. Long-term global longitudinal strain abnormalities in paediatric patients after multisystem inflammatory syndrome in children correlate with cardiac troponin T: a single-centre cohort study. Cardiol Young 2024:1-10. [PMID: 38584315 DOI: 10.1017/s1047951124000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children is an inflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 with a high risk of cardiovascular complications (vasoplegia, cardiac shock). We investigated the cardiac outcomes in multisystem inflammatory syndrome in children, focusing on the identification of predictors for late cardiac function impairment. METHODS Clinical characteristics, conventional echocardiography (left ventricle ejection fraction, fractional shortening), 4-chamber left ventricular global longitudinal strain, and cardiac MRI of multisystem inflammatory syndrome in children patients (n = 48) were collected during admission, 6 weeks, 6 months, >12-≤18 months, and >18-≤24 months post-onset. Paired over-time patterns were assessed and multivariable regression analyses were performed to identify predictors for late global longitudinal strain impairment. RESULTS In total, 81.3% of patients had acute cardiac dysfunction (left ventricle ejection fraction <50% and/or fractional shortening <28%). The left ventricle ejection fraction and fractional shortening reached a plateau level ≤6 weeks, while the global longitudinal strain continued to decrease in the first 6 months post-onset (median -17.3%, P < 0.001 [versus acute]). At 6 months, 35.7% of the patients still had an abnormal global longitudinal strain, which persisted in 5/9 patients that underwent echocardiography >12-≤18 months post-onset and in 3/3 patients >18-≤24 months post-onset. In a multivariable analysis, soluble troponin T (>62.0 ng/L [median]) was associated with reduced global longitudinal strain at 6 months. Our cardiac MRI findings indicated acute myocardial involvement (increased T1/T2 value) in 77.8% (7/9), which recovered quickly without signs of fibrosis on convalescent cardiac MRIs. CONCLUSIONS Late global longitudinal strain impairment is seen in some multisystem inflammatory syndrome in children patients up to one-year post-onset. Careful cardiac follow-up in patients with elevated troponin in the acute phase and patients with persistent abnormal global longitudinal strain is warranted until resolution of the global longitudinal strain since the long-term implications of such abnormalities are still unclear.
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Affiliation(s)
- Stejara A Netea
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
| | - Giske Biesbroek
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - R N Nils Planken
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Nico A Blom
- Emma Children's Hospital, Paediatric Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Pediatric Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Taco W Kuijpers
- Emma Children's Hospital, Paediatric Immunology, Rheumatology and Infectious Disease, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Molecular Haematology, Sanquin Research Institute, Amsterdam, The Netherlands
| | - Irene M Kuipers
- Emma Children's Hospital, Paediatric Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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McAree D, Hauck A, Arzu J, Carr M, Acevedo J, Patel AB, Husain N. Clinical Predictors of Subacute Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol 2024; 45:876-887. [PMID: 36260103 PMCID: PMC9580417 DOI: 10.1007/s00246-022-03021-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 12/01/2022]
Abstract
Multisystem Inflammatory Syndrome in Children (MIS-C) often involves a post-viral myocarditis and associated left ventricular dysfunction. We aimed to assess myocardial function by strain echocardiography after hospital discharge and to identify risk factors for subacute myocardial dysfunction. We conducted a retrospective single-center study of MIS-C patients admitted between 03/2020 and 03/2021. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-ventricular circumferential strain (CS), and left atrial strain (LAS) were measured on echocardiograms performed 3-10 weeks after discharge and compared with controls. Among 60 MIS-C patients, hypotension (65%), ICU admission (57%), and vasopressor support (45%) were common, with no mortality. LVEF was abnormal (< 55%) in 29% during hospitalization but only 4% at follow-up. Follow-up strain abnormalities were prevalent (GLS abnormal in 13%, 4C-LS in 18%, CS in 16%, LAS in 5%). Hypotension, ICU admission, ICU and hospital length of stay, and any LVEF < 55% during hospitalization were factors associated with lower strain at follow-up. Higher peak C-reactive protein (CRP) was associated with hypotension, ICU admission, total ICU days, and with lower follow-up GLS (r = - 0.55; p = 0.01) and CS (r = 0.41; p = 0.02). Peak CRP < 18 mg/dL had negative predictive values of 100% and 88% for normal follow-up GLS and CS, respectively. A subset of MIS-C patients demonstrate subclinical systolic and diastolic function abnormalities at subacute follow-up. Peak CRP during hospitalization may be a useful marker for outpatient cardiac risk stratification. MIS-C patients with hypotension, ICU admission, any LVEF < 55% during hospitalization, or a peak CRP > 18 mg/dL may warrant closer monitoring than those without these risk factors.
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Affiliation(s)
- Daniel McAree
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Amanda Hauck
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Michael Carr
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Jennifer Acevedo
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
| | - Ami B. Patel
- Department of Infectious Diseases, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Nazia Husain
- Department of Pediatric Cardiology, Northwestern University Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611 USA
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Sabri MR, Ahmadi A, Saviz M, Ghaderian M, Dehghan B, Mahdavi C, Ramezani Nezhad D, Rahimi H, Mostafavi N, Pourmoghaddas Z. Cardiac Function in Pediatric Patients with MIS-C Using Speckle Tracking and Conventional Echocardiography: A Longitudinal, Single-Center Study. Pediatr Cardiol 2024:10.1007/s00246-024-03432-w. [PMID: 38431886 DOI: 10.1007/s00246-024-03432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
Cardiovascular involvement in Multisystem Inflammatory Syndrome in Children (MIS-C), a potential consequence of coronavirus disease-2019 (COVID-19), is common. Conventional transthoracic echocardiography (TTE) provides primary data on the function of the left and right ventricles, while Speckle Tracking Echocardiography (STE) is more sensitive. This study aims to assess longitudinal cardiac function using STE in these patients. This longitudinal study was conducted from late 2021 to early 2022 at Imam Hossein Children's Hospital, Isfahan. Cardiac function was assessed by STE at the time of diagnosis and again two months later. Demographics, clinical characteristics, ECG interpretations, imaging studies, and serum cardiac marker levels were collected. Thirty-five pediatric patients with a mean age of 5.1 years (range: 4 months to 17 years) were included and prospectively followed. Twenty-nine of them, comprising 14 males (48.3%) and 15 females (51.7%), underwent STE and were compared with 29 healthy age- and sex-matched children. Factors related to adverse events included reduced myocardial function, enlarged left atrium or ventricle, and mitral regurgitation (MR). Patients with comorbidities affecting strain measurements were excluded from the strain analyses. A significant difference was observed between the groups in regional strains in the basal and apical septal and middle lateral regions. Global strain rate (GLS) and strain rates were not significantly different but were still lower than the control group. Twenty percent of patients had abnormal GLS but normal left ventricular ejection fraction (LVEF). All patients exhibited reduced segmental myocardial strain in at least one segment. Four out of 26 recovered patients without comorbidities had abnormal GLS at follow-up, despite normal LVEF. STE proves more useful than conventional echocardiography in patients with MIS-C, revealing subclinical cardiac injury in the acute and post-acute phases.
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Affiliation(s)
- Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdieh Saviz
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Chehreh Mahdavi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Ramezani Nezhad
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Rahimi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naseroldin Mostafavi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Pourmoghaddas
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Karagözlü S, Ramoğlu MG, Bayram Ö, Bakhtiyarzada J, Aydın A, Yılmaz MM, Murt B, Özkan E, İnceli HB, Gurbanov A, Şükriye Y, Demir B, Özdemir H, Çiftçi E, Kendirli T, Uçar T, Fitoz ÖS, Tutar E. Cardiovascular manifestations and cardiac magnetic resonance follow-up of multisystem inflammatory syndrome in children (MIS-C). Cardiol Young 2024; 34:291-300. [PMID: 37381829 DOI: 10.1017/s1047951123001348] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE This study aimed to evaluate the cardiovascular manifestations and surveillance of multisystem inflammatory syndrome in children (MIS-C) and to determine the correlation of echocardiographic findings with cardiac magnetic resonance imaging findings. METHODS Forty-four children diagnosed as MIS-C with cardiac involvement were enrolled in this observational descriptive study. The diagnosis of MIS-C was made according to the criteria of Centers for Disease Control and Prevention. Clinical findings, laboratory parameters, and electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance was performed on 28 (64%) cases. The 1-year follow-up imaging was performed in all cases with abnormal initial cardiac magnetic resonance findings. RESULTS Forty-four patients (56.8% male) with a mean age of 8.5 ± 4.8 years were enrolled in this study. There was a significant positive correlation between high-sensitivity cardiac troponin T (mean: 162 ± 444.4 pg/ml) and N-terminal pro b-type natriuretic peptide (mean: 10,054 ± 11,604 pg/ml) (p < 0.01). Number of cases with an electrocardiographic and echocardiographic abnormality was 34 (77%) and 31 (70%), respectively. Twelve cases (45%) had left ventricular systolic dysfunction and 14 (32%) cases had pericardial effusion on admission. Three cases (11%) had cardiac magnetic resonance findings that may be attributed to the presence of myocardial inflammation, and pericardial effusion was present in seven (25%) cases. Follow-up cardiac magnetic resonances of all cases were normal. Cardiac abnormalities were completely resolved in all except two cases. CONCLUSIONS Myocardial involvement can be seen during acute disease, but MIS-C generally does not lead to prominent damage during a year of surveillance. Cardiac magnetic resonance is a valuable tool to evaluate the degree of myocardial involvement in cases with MIS-C.
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Affiliation(s)
- Selen Karagözlü
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet G Ramoğlu
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Özlem Bayram
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Jeyhun Bakhtiyarzada
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Alperen Aydın
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet Mustafa Yılmaz
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Begüm Murt
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Ersin Özkan
- Ankara University, School of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Hatice Belkıs İnceli
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Anar Gurbanov
- Ankara University, School of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Yılmaz Şükriye
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Berrin Demir
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Halil Özdemir
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ergin Çiftçi
- Ankara University, School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Tanıl Kendirli
- Ankara University, School of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Tayfun Uçar
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
| | - Ömer Suat Fitoz
- Ankara University, School of Medicine, Department of Pediatric Radiology, Ankara, Turkey
| | - Ercan Tutar
- Ankara University, School of Medicine, Department of Pediatric Cardiology, Ankara, Turkey
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Carmona CA, Kuziez M, Freitas CF, Cyrus JW, Bain J, Karam O. Cardiac manifestations of multisystem inflammatory syndrome of children after SARS-CoV-2 infection: a systematic review and meta-analysis. Cardiol Young 2023; 33:2319-2327. [PMID: 36762563 DOI: 10.1017/s104795112300015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This systematic review and meta-analysis were conducted to evaluate the prevalence of cardiac manifestations associated with multisystem inflammatory syndrome in children worldwide. We conducted electronic searches in Ovid MEDLINE, Ovid EMBASE, and the World Health Organization COVID-19 Literature Database from the inception of the SARS-CoV-2 pandemic to 1 January, 2022. Three authors independently screened the abstracts to determine eligibility, assessed methodology in the full texts, and extracted the data.We identified 2848 citations; 94 studies (14,932 patients) were included. The prevalence of vasopressors was 48.2% (95% CI 45.1%, 51.3%), left ventricular systolic dysfunction occurred in 37.2% (95% CI 34.1%, 40.3%), myocarditis in 34.1% (95% CI 30.5%, 37.8%), electrocardiographic dysrhythmias and abnormalities detected in 23.1% (95% CI 18.8%, 27.6%), coronary abnormalities identified in 18% (95% CI 16%, 20%), extracorporeal membrane oxygenation deployed in 2.2% (95% CI 1.7%, 2.8%), and mortality rate of 2.2% (95% CI 1.7%, 2.7%). A sensitivity analysis was performed after removing eleven studies with high bias, and the adjusted prevalence was not different than the original evaluation.In this meta-analysis of the largest cohort of multisystem inflammatory syndrome in children patients to date, we established the most accurate prevalence of the most common cardiac manifestations. Providers will subsequently have more precise data to anticipate patient outcomes and approach discussions concerning the frequency of monitoring outside the acute hospital period.
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Affiliation(s)
- Carlos A Carmona
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Mohamed Kuziez
- Division of Pediatric Cardiology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Caio F Freitas
- Division of Pediatrics, Advent Health for Children, Pediatrics Residency, Orlando, FL, USA
| | - John W Cyrus
- Tompkins-McCaw Library for the Health Sciences, VCU Libraries, Virginia Commonwealth University, Richmond, VA, USA
| | - Jesse Bain
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Broberg MC, Mazer MB, Cheifetz IM. Cardiovascular effects of COVID-19 in children. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:533-541. [PMID: 38920204 DOI: 10.47102/annals-acadmedsg.202386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Although severe acute respiratory failure is the primary cause of morbidity and mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, this viral infection leads to cardiovascular disease in some individuals. Cardiac effects of the virus include myocarditis, pericarditis, arrhythmias, coronary aneurysms and cardiomyopathy, and can result in cardiogenic shock and multisystem organ failure. Method This review summarises cardiac manifesta-tions of SARS-CoV-2 in the paediatric population. We performed a scoping review of cardiovascular disease associated with acute coronavirus disease 2019 (COVID-19) infection, multisystem inflammatory syndrome in children (MIS-C), and mRNA COVID-19 vaccines. Also examined are special considerations for paediatric athletes and return to play following COVID-19 infection. Results Children presenting with acute COVID-19 should be screened for cardiac dysfunction and a thorough history should be obtained. Further cardiovascular evaluation should be considered following any signs/symptoms of arrhythmias, low cardiac output, and/or myopericarditis. Patients admitted with severe acute COVID-19 should be monitored with continuous cardiac monitoring. Laboratory testing, as clinically indicated, includes tests for troponin and B-type natriuretic peptide or N-terminal pro-brain natriuretic peptide. Echocardiography with strain evaluation and/or cardiac magnetic resonance imaging should be considered to evaluate diastolic and systolic dysfunction, coronary anatomy, the pericardium and the myocardium. For patients with MIS-C, combination therapy with intravenous immunoglobulin and glucocorticoid therapy is safe and potentially disease altering. Treatment of MIS-C targets the hyperimmune response. Supportive care, including mechanical support, is needed in some cases. Conclusion Cardiovascular disease is a striking feature of SARS-CoV-2 infection. Most infants, children and adolescents with COVID-19 cardiac disease fully recover with no lasting cardiac dysfunction. However, long-term studies and further research are needed to assess cardiovascular risk with variants of SARS-CoV-2 and to understand the pathophysiology of cardiac dysfunction with COVID-19.
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Affiliation(s)
- Meredith Cg Broberg
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Monty B Mazer
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Ira M Cheifetz
- Division of Cardiac Critical Care, UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
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10
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Tijmes FS, Marschner C, Thavendiranathan P, Hanneman K. Magnetic Resonance Imaging of Cardiovascular Manifestations Following COVID-19. J Magn Reson Imaging 2023; 58:26-43. [PMID: 36951477 DOI: 10.1002/jmri.28677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023] Open
Abstract
Globally, over 650 million people have had COVID-19 due to infection with the SARS-Cov-2 virus. Cardiac complications in the acute infectious and early recovery phase were recognized early in the pandemic, including myocardial injury and inflammation. With a decrease in the number of acute COVID-19 related deaths, there has been increased interest in postacute sequela of COVID-19 (PASC) and other longer-term cardiovascular complications. A proportion of patients recovered from COVID-19 have persistent cardiac symptoms and are at risk of cardiovascular disease. Cardiovascular imaging, including MRI, plays an important role in the detection of cardiovascular manifestations of COVID-19 in both the acute and longer-term phases after COVID-19. The purpose of this review is to highlight the role of cardiovascular imaging in the diagnosis and risk stratification of patients with acute and chronic cardiovascular manifestations of COVID-19 with a focus on cardiac MRI. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Felipe Sanchez Tijmes
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile
| | - Constantin Marschner
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Clinica Santa Maria, Universidad de los Andes, Santiago, Chile
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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11
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Cem E, Kıymet E, Böncüoğlu E, Şahinkaya Ş, Yılmaz Çelebi M, Gülderen M, Akaslan Kara A, Meşe T, Ağin H, Bayram N, Devrim İ. Readmission reasons of pediatric patients diagnosed with multisystem inflammatory syndrome after discharge. Arch Rheumatol 2023; 38:315-321. [PMID: 37680520 PMCID: PMC10481694 DOI: 10.46497/archrheumatol.2023.9605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/06/2022] [Indexed: 09/09/2023] Open
Abstract
Objectives There is no clear information in the literature about causes of reactivation of multisystem inflammatory syndrome in children (MIS-C) or indications for readmissions for MIS-C after discharge; as a result, the conditions that may develop after infection in children with MIS-C were discussed, and the reasons for hospitalization were screened. Patients and methods This single-center retrospective study was conducted with 95 patients (65 males, 30 females; mean age: 92.8±55.5 months; range, 5 to 17 months) between November 11, 2020, and December 30, 2021. Children who were rehospitalized in the study center after their discharge with the diagnosis of MIS-C were included in the study, and the indications for readmissions were evaluated. Results During the study period, six (6.3%) patients (4 males, 2 females; median age: 114.5 months [interquartile range: 122 months]) had to be rehospitalized. Four of these patients had an underlying disease, while the other two were previously healthy children. Fever was the most common reason for readmissions in half of the patients, while the remaining patients were readmitted with the indications of myocarditis, pneumonia, and posttraumatic pain syndrome. Conclusion Although no evidence for the reactivation of MIS-C was detected in patients in the literature, it should also be emphasized that close follow-up of these patients is a must, considering possible cardiac complications.
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Affiliation(s)
- Ela Cem
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Elif Kıymet
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Elif Böncüoğlu
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Şahika Şahinkaya
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Miray Yılmaz Çelebi
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Mustafa Gülderen
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Aybüke Akaslan Kara
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Timur Meşe
- Department of Paediatric Cardiology Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Hasan Ağin
- Department of Paediatric Intensive Care, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Nuri Bayram
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - İlker Devrim
- Department of Paediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
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12
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Ferreira VM, Plein S, Wong TC, Tao Q, Raisi-Estabragh Z, Jain SS, Han Y, Ojha V, Bluemke DA, Hanneman K, Weinsaft J, Vidula MK, Ntusi NAB, Schulz-Menger J, Kim J. Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 25:21. [PMID: 36973744 PMCID: PMC10041524 DOI: 10.1186/s12968-023-00933-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.
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Affiliation(s)
- Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford British Heart Foundation Centre of Research Excellence, The National Institute for Health Research Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, University of Leeds, Leeds, UK
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Supriya S Jain
- Division of Pediatric Cardiology, Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, New York, USA
| | - Yuchi Han
- Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, USA
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Jonathan Weinsaft
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital; Cape Heart Institute, University of Cape Town, South African Medical Research Council Extramural Unit On Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité and MDC, Charité University Medicine, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine/New York Presbyterian Hospital, Weill Cornell Medical College, New York, USA.
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13
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DiLorenzo MP, Farooqi KM, Shah AM, Channing A, Harrington JK, Connors TJ, Martirosyan K, Krishnan US, Ferris A, Weller RJ, Farber DL, Milner JD, Gorelik M, Rosenzweig EB, Anderson BR. Ventricular function and tissue characterization by cardiac magnetic resonance imaging following hospitalization for multisystem inflammatory syndrome in children: a prospective study. Pediatr Radiol 2023; 53:394-403. [PMID: 36255453 PMCID: PMC9579624 DOI: 10.1007/s00247-022-05521-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a severe life-threatening manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that often presents with acute cardiac dysfunction and cardiogenic shock. While recovery from acute illness is excellent, the long-term myocardial impact is unknown. OBJECTIVE To compare cardiac MRI findings in children 6-9 months after their hospitalization with MIS-C against MRI findings in healthy controls to assess for residual myocardial disease. MATERIALS AND METHODS We prospectively performed cardiac MRI on 13 children 6-9 months following their hospitalization with MIS-C: eight of these children had a history of left ventricle ejection fraction (LVEF) < 50%, persistent symptoms, or electrocardiogram (ECG) abnormalities and underwent clinical MRI; five of these children without cardiac abnormalities during their hospitalization underwent research MRIs. We compared their native T1 and T2 mapping values with those of 20 normal controls. RESULTS Cardiac MRI was performed at 13.6 years of age (interquartile range [IQR] 11.9-16.4 years) and 8.2 months (IQR 6.8-9.6 months) following hospitalization. Twelve children displayed normal ejection fraction: left ventricle (LV) 57.2%, IQR 56.1-58.4; right ventricle (RV) 53.1%, IQR 52.0-55.7. One had low-normal LVEF (52%). They had normal extracellular volume (ECV) and normal T2 and native T1 times compared to controls. There was no qualitative evidence of edema. One child had late gadolinium enhancement (LGE) with normal ejection fraction, no edema, and normal T1 and T2 times. When stratifying children who had MIS-C according to history of LVEF <55% on echocardiography, there was no difference in MRI values. CONCLUSION Although many children with MIS-C present acutely with cardiac dysfunction, residual myocardial damage 6-9 months afterward appears minimal. Long-term implications warrant further study.
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Affiliation(s)
- Michael P DiLorenzo
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA.
| | - Kanwal M Farooqi
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Amee M Shah
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Alexandra Channing
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Jamie K Harrington
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Karen Martirosyan
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Usha S Krishnan
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Anne Ferris
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Rachel J Weller
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Donna L Farber
- Department of Microbiology and Immunology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Joshua D Milner
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Mark Gorelik
- Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
| | - Brett R Anderson
- Department of Pediatrics, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, CHN2, New York, NY, 10032, USA
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14
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Petrovic D, Benzon B, Srsen S, Polic B, Vukovic Novogradec A, Milic P, Markic J. The Impact of Vitamin D Levels on Clinical Manifestations of Multisystem Inflammatory Syndrome in Children: A Cross-Sectional Study. Life (Basel) 2023; 13:674. [PMID: 36983830 PMCID: PMC10057472 DOI: 10.3390/life13030674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hyperinflammatory response that resembles Kawasaki disease may develop in children after COVID-19 disease, and it is called multisystem inflammatory syndrome in children. The cause of MIS-C is dysregulated innate immune response and a subsequent cytokine storm that results in endothelial damage. It has been determined that low levels of serum 25(OH)D increase the risk of developing immune-related diseases and disorders. METHODS To determine the incidence of hypovitaminosis D, and a possible correlation between 25(OH)D levels and the clinical severity of MIS-C, 21 patients hospitalized in the University Hospital of Split due to MIS-C were evaluated. RESULTS Hypovitaminosis D was detected in 95% of MIS-C patients. We found a significant relationship between the severity of MIS-C and 25(OH)D levels, as patients with more severe MIS-C had lower 25(OH)D. MIS-C patients with lower vitamin D levels had worse systolic and diastolic function of the left ventricle according to echocardiograms. There was no relationship between 25(OH)D levels and the tested laboratory inflammatory and cardiac markers. CONCLUSION Hypovitaminosis D is very common in children with MIS-C and influences the severity of the disease. VD could be a new potential biomarker in MIS-C, and VD replacement therapy should be considered early on in the treatment of MIS-C.
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Affiliation(s)
- Davor Petrovic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Benjamin Benzon
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Sasa Srsen
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Branka Polic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | | | - Petra Milic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
| | - Josko Markic
- Department of Pediatrics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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15
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Özgür Gündeşlioğlu Ö, Subaşı B, Pişkin F, Atmış A, Demir F, Erdem S, Alabaz D, Çay Ü, Tapaç N, Kılınç F, Kaymaz ST, Özgür Horoz Ö, Yıldızdaş RD, Ünal İ. Cardiac effects of multisystem inflammatory syndrome in children: One-year follow-up. J Paediatr Child Health 2023; 59:637-643. [PMID: 36786503 DOI: 10.1111/jpc.16363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
AIM Cardiovascular involvement is common among children with multisystem inflammatory syndrome (MIS-C) and can cause shock and death. In this study, we evaluated the early and long-term cardiac effects of MIS-C. METHODS In this observational cohort study, we included all children treated for MIS-C from October 2020 to November 2021 in the Department of Paediatric Infectious Disease at Cukurova University School of Medicine Hospital. The patients underwent serial echocardiographical evaluation during hospitalisation and at 1, 3, 6 and 12 months after discharge. The patients were evaluated using Holter monitorisation between 4 and 6 months and using cardiac magnetic resonance imaging at 6 months and thereafter. RESULTS Twenty-six patients diagnosed with MIS-C and with a median age of 84 months were included. Cardiac involvement was found in 19 (73.1%) patients. At initial echocardiographic evaluation, the mean ejection fraction value of the patients was 56.7% (range: 30-75). Coronary artery dilatation was detected in two (7.7%) patients, and mitral regurgitation persisted in only one patient by month 3. Treatment was started in two (7.7%) patients due to ventricular arrhythmia. Cardiac magnetic resonance imaging was performed in 13 (50%) patients at a median of 6 months (range: 5-9). The cardiac magnetic resonance imaging findings were consistent with possible interstitial fibrosis in two (7.7%) patients. CONCLUSION Our results showed that cardiac involvement of patients improved rapidly with treatment, as indicated by previous studies. However, during the 1-year follow-up, frequent extraventricular systole was detected in two patients, one of whom initially did not show cardiac involvement. Moreover, possible interstitial fibrosis was detected in the cardiac magnetic resonance imaging (MRI) evaluation of two patients. In particular, we believe that these findings may be useful to evaluate critically ill paediatric patients and patients with severely low EF with cardiac MRI in their follow-up.
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Affiliation(s)
- Özlem Özgür Gündeşlioğlu
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Berivan Subaşı
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Ferhat Pişkin
- Department of Radiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Anıl Atmış
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Sevcan Erdem
- Department of Pediatric Cardiology, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Ümmühan Çay
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Nisanur Tapaç
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Fatma Kılınç
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Selime T Kaymaz
- Department of Pediatric Infectious Diseases, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Özden Özgür Horoz
- Department of Pediatric Intensive Care, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - Rıza D Yıldızdaş
- Department of Pediatric Intensive Care, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, School of Medicine, Balcalı Hospital, Cukurova University, Adana, Turkey
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16
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COVID-19 Heart Lesions in Children: Clinical, Diagnostic and Immunological Changes. Int J Mol Sci 2023; 24:ijms24021147. [PMID: 36674665 PMCID: PMC9866514 DOI: 10.3390/ijms24021147] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
In the beginning of COVID-19, the proportion of confirmed cases in the pediatric population was relatively small and there was an opinion that children often had a mild or asymptomatic course of infection. Our understanding of the immune response, diagnosis and treatment of COVID-19 is highly oriented towards the adult population. At the same time, despite the fact that COVID-19 in children usually occurs in a mild form, there is an incomplete understanding of the course as an acute infection and its subsequent manifestations such as Long-COVID-19 or Post-COVID-19, PASC in the pediatric population, correlations with comorbidities and immunological changes. In mild COVID-19 in childhood, some authors explain the absence of population decreasing T and B lymphocytes. Regardless of the patient's condition, they can have the second phase, related to the exacerbation of inflammation in the heart tissue even if the viral infection was completely eliminated-post infectious myocarditis. Mechanism of myocardial dysfunction development in MIS-C are not fully understood. It is known that various immunocompetent cells, including both resident inflammatory cells of peripheral tissues (for example macrophages, dendritic cells, resident memory T-lymphocytes and so on) and also circulating in the peripheral blood immune cells play an important role in the immunopathogenesis of myocarditis. It is expected that hyperproduction of interferons and the enhanced cytokine response of T cells 1 and 2 types contribute to dysfunction of the myocardium. However, the role of Th1 in the pathogenesis of myocarditis remains highly controversial. At the same time, the clinical manifestations and mechanisms of damage, including the heart, both against the background and after COVID-19, in children differ from adults. Further studies are needed to evaluate whether transient or persistent cardiac complications are associated with long-term adverse cardiac events.
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17
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Longitudinal Assessment of Cardiac Function Following Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023; 44:607-617. [PMID: 35864203 PMCID: PMC9302868 DOI: 10.1007/s00246-022-02972-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 12/04/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 is commonly associated with cardiac involvement. Studies found myocardial dysfunction, as measured by decreased ejection fraction and abnormal strain, to be common early in illness. However, there is limited data on longitudinal cardiac outcomes. We aim to describe the evolution of cardiac findings in pediatric MIS-C from acute illness through at least 2-month follow-up. A retrospective single-center review of 36 patients admitted with MIS-C from April 2020 through September 2021 was performed. Echocardiographic data including cardiac function and global longitudinal strain (GLS) were analyzed at initial presentation, discharge, 2-4-week follow-up, and at least 2-month follow-up. Patients with mild and severe disease, normal and abnormal left ventricular ejection fraction (LVEF), and normal and abnormal GLS at presentation were compared. On presentation, 42% of patients with MIS-C had decreased LVEF < 55%. In patients in whom GLS was obtained (N = 18), 44% were abnormal (GLS < |- 18|%). Of patients with normal LVEF, 22% had abnormal GLS. There were no significant differences in troponin or brain natriuretic peptide between those with normal and abnormal LVEF. In most MIS-C patients with initial LVEF < 55% (90%), LVEF normalized upon discharge. At 2-month follow-up, all patients had normal LVEF with 21% having persistently abnormal GLS. Myocardial systolic dysfunction and abnormal deformation were common findings in MIS-C at presentation. While EF often normalized by 2 months, persistently abnormal GLS was more common, suggesting ongoing subclinical dysfunction. Our study offers an optimistic outlook for recovery in patients with MIS-C and carditis, however ongoing investigation for longitudinal effects is warranted.
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18
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Benvenuto S, Simonini G, Della Paolera S, Abu Rumeileh S, Mastrolia MV, Manerba A, Chicco D, Belgrano M, Caiffa T, Cattalini M, Taddio A. Cardiac MRI in midterm follow-up of MISC: a multicenter study. Eur J Pediatr 2023; 182:845-854. [PMID: 36484863 PMCID: PMC9734924 DOI: 10.1007/s00431-022-04748-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED In this multicenter retrospective study we aimed to evaluate the outcome of cardiac involvement in children affected by multisystem inflammatory syndrome (MIS-C), assessed through cardiac magnetic resonance (CMR). Children referring to three Italian tertiary pediatric centers between February 2020 and November 2021 with a diagnosis of MIS-C, who underwent CMR during a follow-up visit, were enrolled. Demographic, clinical, laboratory, treatment, and outcome data were collected. Twenty MIS-C patients (aged 9-17, median 12 years) were included in the study. Heart involvement at onset was testified by hypotension/shock (55%), laboratory evidence of myocardial involvement (100%), reduced LV ejection fraction (EF) on echocardiography (83%), and/or need for inotrope agents (40%); they all presented good clinical, laboratory, and echocardiographic response to treatment. CMR was performed after a median interval of 3 months from discharge. Pericardial effusion and myocardial edema were found in 5% of patients. Mild residual left ventricular (LV) dysfunction was found in 20% of patients, all showing normal echocardiographic LVEF at discharge. Minimal myocardial scars were found in 25% by late gadolinium enhancement (LGE). One patient was evaluated at two consecutive time points, showing partial resolution of a myocardial scar after 7 months from its first finding. CONCLUSION Despite the severity of heart involvement in the acute MIS-C phase, the mid-term cardiac outcome is good. Direct cardiac tissue viral invasion may be involved in MIS-C pathogenesis. WHAT IS KNOWN • Heart involvement is common in MIS-C, but conflicting findings have been shown regarding cardiac outcome when assessed through cardiac MRI. WHAT IS NEW • Midterm cardiac MRI shows mild abnormalities in patients recovered from MIS-C with any grade of severity of cardiac involvement at presentation.
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Affiliation(s)
| | - Gabriele Simonini
- grid.8404.80000 0004 1757 2304NEUROFARBA Department, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Sara Della Paolera
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Sarah Abu Rumeileh
- grid.413181.e0000 0004 1757 8562Rheumatology Unit, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Maria Vincenza Mastrolia
- grid.8404.80000 0004 1757 2304NEUROFARBA Department, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Alessandra Manerba
- grid.412725.7Pediatric Cardiology, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Daniela Chicco
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Manuel Belgrano
- grid.5133.40000 0001 1941 4308Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Thomas Caiffa
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marco Cattalini
- grid.7637.50000000417571846Pediatric Clinic, University of Brescia, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Andrea Taddio
- grid.5133.40000 0001 1941 4308University of Trieste, Via dell’Istria 65/1, Trieste, Italy ,grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
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Arslan SY, Bal ZS, Bayraktaroglu S, Ozenen GG, Bilen NM, Levent E, Ay O, Ozkaya PY, Ozkinay F, Cicek C, Cinkooglu A, Aksu G, Ak G, Kurugol Z. Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features. Pediatr Cardiol 2023; 44:44-53. [PMID: 35916926 PMCID: PMC9343565 DOI: 10.1007/s00246-022-02977-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 01/24/2023]
Abstract
Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2-4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2-6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients' MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2-6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.
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Affiliation(s)
- Sema Yildirim Arslan
- grid.8302.90000 0001 1092 2592Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Zumrut Sahbudak Bal
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey.
| | - Selen Bayraktaroglu
- grid.8302.90000 0001 1092 2592Department of Radiology, Medical School of Ege University, Izmir, Turkey
| | - Gizem Guner Ozenen
- grid.8302.90000 0001 1092 2592Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Nimet Melis Bilen
- grid.8302.90000 0001 1092 2592Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Erturk Levent
- grid.8302.90000 0001 1092 2592Division of Pediatric Cardiology, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Oguzhan Ay
- grid.8302.90000 0001 1092 2592Division of Pediatric Cardiology, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Pinar Yazici Ozkaya
- grid.8302.90000 0001 1092 2592Division of Pediatric Intensive Care Unit, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Ferda Ozkinay
- grid.8302.90000 0001 1092 2592Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Candan Cicek
- grid.8302.90000 0001 1092 2592Department of Microbiology, Medical School of Ege University, Izmir, Turkey
| | - Akin Cinkooglu
- grid.8302.90000 0001 1092 2592Department of Radiology, Medical School of Ege University, Izmir, Turkey
| | - Guzide Aksu
- grid.8302.90000 0001 1092 2592Division of Immunology and Rheumatology, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
| | - Gunes Ak
- grid.8302.90000 0001 1092 2592Department of Clinic Biochemistry, Medical School of Ege University, Izmir, Turkey
| | - Zafer Kurugol
- grid.8302.90000 0001 1092 2592Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir, Turkey
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20
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Sabatino J, Di Chiara C, Di Candia A, Sirico D, Donà D, Fumanelli J, Basso A, Pogacnik P, Cuppini E, Romano LR, Castaldi B, Reffo E, Cerutti A, Biffanti R, Cozzani S, Giaquinto C, Di Salvo G. Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19. J Clin Med 2022; 12:jcm12010186. [PMID: 36614987 PMCID: PMC9820895 DOI: 10.3390/jcm12010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Although most children may experience mild to moderate symptoms and do not require hospitalization, there are little data on cardiac involvement in COVID-19. However, cardiac involvement is accurately demonstrated in children with MISC. The objective of this study was to evaluate cardiac mechanics in previously healthy children who recovered from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up by means of two-dimensional speckle-tracking echocardiography (STE). Methods: We analyzed a cohort of 157 paediatric patients, mean age 7.7 ± 4.5 years (age range 0.3−18 years), who had a laboratory-confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent a standard transthoracic echocardiogram and STE at an average time of 148 ± 68 days after diagnosis and were divided in three follow-up groups (<180 days, 180−240 days, >240 days). Patients were compared with 107 (41 females—38%) age- and BSA-comparable healthy controls (CTRL). Results: Left ventricular (LV) global longitudinal strain (post-COVID-19: −20.5 ± 2.9%; CTRL: −21.8 ± 1.7%; p < 0.001) was significantly reduced in cases compared with CTRLs. No significant differences were seen among the three follow-up groups (p = NS). Moreover, regional longitudinal strain was significantly reduced in LV apical-wall segments of children with disease onset during the second wave of the COVID-19 pandemic compared to the first wave (second wave: −20.2 ± 2.6%; first wave: −21.2 ± 3.4%; p = 0.048). Finally, peak left atrial systolic strain was within the normal range in the post-COVID-19 group with no significant differences compared to CTRLs. Conclusions: Our study demonstrated for the first time the persistence of LV myocardial deformation abnormalities in previously healthy children with an asymptomatic or mildly symptomatic (WHO stages 0 or 1) COVID-19 course after an average follow-up of 148 ± 68 days. A more significant involvement was found in children affected during the second wave. These findings imply that subclinical LV dysfunction may also be a typical characteristic of COVID-19 infection in children and are concerning given the predictive value of LV longitudinal strain in the general population.
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Affiliation(s)
- Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
- Correspondence: (J.S.); (G.D.S.)
| | - Costanza Di Chiara
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Angela Di Candia
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Domenico Sirico
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Daniele Donà
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Jennifer Fumanelli
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Alessia Basso
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Pietro Pogacnik
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Elena Cuppini
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Letizia Rosa Romano
- Department of Medical and Surgical Sciences, Division of Cardiology, Magna Graecia University of Catanzaro, Viale Europa 1, 88100 Catanzaro, Italy
| | - Biagio Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Elena Reffo
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Alessia Cerutti
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Roberta Biffanti
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Sandra Cozzani
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
| | - Giovanni Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padova, Italy
- Correspondence: (J.S.); (G.D.S.)
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21
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Goudarzi E, Yousefimoghaddam F, Ramandi A, Khaheshi I. 2D speckle-tracking echocardiography as a prognostic imaging modality for COVID-19 adverse outcomes. Future Cardiol 2022; 18:949-956. [PMID: 36321772 PMCID: PMC9629288 DOI: 10.2217/fca-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
2D speckle-tracking echocardiography (2D-STE) has been used to assess cardiac recovery during the COVID-19 patient follow-ups within the pandemic. The novel role of STE in predicting adverse outcomes of COVID-19 has received attention due to its high sensitivity in identifying subclinical myocardial dysfunction. We reviewed the studies on using 2D-STE to assess COVID-19 prognosis. A literature search was conducted on PubMed and Scopus for eligible articles, 24 of which discussed using prognostic 2D-STE for COVID-19 patients. 2D-STE predicts cardiovascular impairments more rapidly and precisely than conventional echocardiography. The 2D-STE technique presents an independent prognostic factor in COVID-19 infection. 2D-STE could be considered a time-efficient and accurate risk predictor of all-cause mortality in COVID-19 patients.
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Affiliation(s)
- Ehsan Goudarzi
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Yousefimoghaddam
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ramandi
- 2School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,3Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Author for correspondence: Tel.: +98 21 2208 3106;
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22
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Special Issue “COVID-19: Diagnostic Imaging and Beyond—Part II”. J Clin Med 2022; 11:jcm11133786. [PMID: 35807071 PMCID: PMC9267225 DOI: 10.3390/jcm11133786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
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23
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Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060917. [PMID: 35740854 PMCID: PMC9222005 DOI: 10.3390/children9060917] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction.
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24
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Dove ML, Oster ME, Hashemi S, Slesnick TC. Cardiac Magnetic Resonance Findings after Multisystem Inflammatory Syndrome in Children. J Pediatr 2022; 245:95-101. [PMID: 35240139 DOI: 10.1016/j.jpeds.2022.02.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the cardiac magnetic resonance (MR) findings of children recovered from multisystem inflammatory syndrome in children (MIS-C) longer than 3 months after acute illness. STUDY DESIGN We performed a retrospective cohort study of children hospitalized with MIS-C at a single institution receiving cardiac MR imaging between July 2020 and May 2021. Patient demographics, echocardiogram data from diagnosis through follow-up, and cardiac MR data obtained at approximately 3 months after hospitalization were recorded. RESULTS In total, 51 children with a median age of 11.3 years were included; 80% of patients had left ventricular ejection fraction <55%, 65% of patients developed valvular regurgitation, and 20% of patients developed coronary artery dilation during acute illness. Cardiac MR was performed at a median time of 105 days after diagnosis; 8% of patients had left ventricular ejection fraction <55%; 1 patient had residual valvular regurgitation; and 2 patients had residual coronary artery dilation. Two of 51 patients were found to have late gadolinium enhancement, T1 mapping abnormalities, and abnormal or borderline extracellular volume calculations suggesting myocardial fibrosis. No patient had T2 mapping abnormalities corresponding with edema, and no patient met the modified Lake Louise criteria for acute myocarditis; 10 of 51 patients had isolated elevated T1 values. CONCLUSIONS At 3-5 months following diagnosis, cardiac MR reveals no evidence of acute myocarditis as described by the modified Lake Louise criteria in patients with MIS-C. Two patients were observed to have myocardial fibrosis without regional wall motion abnormalities, and 10 had isolated imaging changes (elevated T1 values) in the absence of macroscopic fibrosis.
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Affiliation(s)
- Matthew L Dove
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Matthew E Oster
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sassan Hashemi
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Timothy C Slesnick
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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25
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Campanello C, Mercuri C, Derchi M, Trocchio G, Consolaro A, Caorsi R, Ravelli A, Rimini A, Marasini M, Gattorno M. Cardiovascular Manifestations in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19 According to Age. CHILDREN 2022; 9:children9050583. [PMID: 35626760 PMCID: PMC9139768 DOI: 10.3390/children9050583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
Cardiac involvement in multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus-19 disease is often observed with a high risk of heart failure. The aim is to describe cardiovascular involvement, management and early outcome in MIS-C by comparing cardiovascular manifestations in children younger and older than 6 years old. This retrospective observational study included 25 children with MIS-C, admitted to a single pediatric center between March 2020 and September 2021. The median age was 5 years (13 patients under 6 years and 12 over 6 years); coronary artery abnormalities were observed in 77% of preschoolers, with small and medium aneurysms in half of the cases and two cases of mild ventricular dysfunction. School-age children presented myopericardial involvement with mild to moderate ventricular dysfunction in 67% of cases, and two cases of transient coronary dilatation. There was a significant NT-pro-BNP and inflammatory markers increase in 25 of the patients, and mild elevation of troponin I in 9. All patients were treated with intravenous immunoglobulin and corticosteroids, and 8 with anakinra. None of the patients needed inotropes or intensive care unit admission. Our study shows the frequent cardiovascular involvement in MIS-C with a peculiar distribution, according to different age group: coronary artery anomalies were more frequent in the younger group, and myopericardial disease in the older one. A prompt multitarget, anti-inflammatory therapy could probably contribute to a favorable outcome.
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Affiliation(s)
- Claudia Campanello
- Pediatrics and Neonatology Unit, San Paolo Hospital, 17100 Savona, Italy
- Correspondence: ; Tel.: +39-338-904-4757
| | - Claudia Mercuri
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), IRCSS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (C.M.); (A.C.); (A.R.); (M.G.)
| | - Maria Derchi
- Cardiology Unit, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.D.); (G.T.); (A.R.); (M.M.)
| | - Gianluca Trocchio
- Cardiology Unit, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.D.); (G.T.); (A.R.); (M.M.)
| | - Alessandro Consolaro
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), IRCSS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (C.M.); (A.C.); (A.R.); (M.G.)
- Pediatric Rheumatology Department, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Roberta Caorsi
- Pediatric Rheumatology Department, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Angelo Ravelli
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), IRCSS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (C.M.); (A.C.); (A.R.); (M.G.)
- Scientific Direction, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Rimini
- Cardiology Unit, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.D.); (G.T.); (A.R.); (M.M.)
| | - Maurizio Marasini
- Cardiology Unit, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.D.); (G.T.); (A.R.); (M.M.)
| | - Marco Gattorno
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), IRCSS Istituto Giannina Gaslini, University of Genoa, 16147 Genoa, Italy; (C.M.); (A.C.); (A.R.); (M.G.)
- Pediatric Rheumatology Department, IRCSS Istituto Giannina Gaslini, 16147 Genoa, Italy;
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Petersen SE, Friedrich MG, Leiner T, Elias MD, Ferreira VM, Fenski M, Flamm SD, Fogel M, Garg R, Halushka MK, Hays AG, Kawel-Boehm N, Kramer CM, Nagel E, Ntusi NA, Ostenfeld E, Pennell DJ, Raisi-Estabragh Z, Reeder SB, Rochitte CE, Starekova J, Suchá D, Tao Q, Schulz-Menger J, Bluemke DA. Cardiovascular Magnetic Resonance for Patients With COVID-19. JACC Cardiovasc Imaging 2022; 15:685-699. [PMID: 34656482 PMCID: PMC8514168 DOI: 10.1016/j.jcmg.2021.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19-related myocarditis is likely infrequent, COVID-19-related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post-COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19-related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.
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Affiliation(s)
- Steffen E. Petersen
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Tim Leiner
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands,Mayo Clinic, Department of Radiology, Rochester, Minnestoa, USA
| | - Matthew D. Elias
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, United Kingdom
| | - Maximilian Fenski
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - Scott D. Flamm
- Cardiovascular Imaging, Imaging and Heart, Vascular, and Thoracic Institutes, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Fogel
- Department of Pediatrics (Cardiology) and Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ria Garg
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Marc K. Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland,Institute for Diagnostic Interventional Pediatric Radiology, Inselspital, Bern, University Hospital of Bern, Switzerland
| | - Christopher M. Kramer
- Cardiovascular Division, Departments of Medicine and Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Center for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt AM Main, Germany
| | - Ntobeko A.B. Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa,Groote Schuur Hospital, Cape Town, South Africa,Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden,Skåne University Hospital, Lund, Sweden
| | - Dudley J. Pennell
- National Heart and Lung Institute, Imperial College, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Scott B. Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Carlos E. Rochitte
- Heart Institute, InCor, University of São Paulo Medical School and Heart Hospital, Hospital do Coração, São Paulo, Brazil
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Dominika Suchá
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands,Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanette Schulz-Menger
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - David A. Bluemke
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin, USA,Address for correspondence: Dr David A. Bluemke, University of Wisconsin School of Medicine and Public Health, 600 Highland Drive, Madison, Wisconsin 53792, USA
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Kushwaha AD, Mishra KP, Singh M, Ganju L, Saraswat D. Nanocurcumin formulation: a possible therapeutic agent for post COVID inflammatory syndrome. Immunopharmacol Immunotoxicol 2022; 44:141-146. [PMID: 35130792 DOI: 10.1080/08923973.2022.2037631] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the last twenty months, the attention of the world has been focusing on managing the unprecedented and devastating wave of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) and mitigating its impacts. Recent findings indicated that high levels of pro-inflammatory cytokines are leading cause of poor prognosis in severely ill COVID-19 patients. Presently, the multiple variants and highly contagious nature of virus makes challenge humongous. The shortage and vaccine hesitancy also prompted to develop antiviral therapeutic agents to manage this pandemic. Nanocurcumin has potential antiviral activities and also beneficial in post COVID inflammatory complications. We have developed nanocurcumin based formulation using pyrroloquinoline quinone (PQQ) which protects cardio-pulmonary function and mitochondrial homeostasis in hypobaric hypoxia induced right ventricular hypertrophy in animal model and human ventricular cardiomyocytes. Nanocurcumin based formulation (NCF) with improved bioavailability, has proven several holistic therapeutic effects including myocardial protection, and prevents edema formation, anti-inflammatory and antioxidant properties, maintaining metabolic and mitochondrial homeostasis under hypoxic condition. The post COVID-inflammatory syndrome also reported to cause impaired heart function, lung injuries and increased C-reactive protein level in severely ill patients. Thus, we speculate that NCF could be a new treatment option to manage post COVID-19 inflammatory syndrome.
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Affiliation(s)
- Asha D Kushwaha
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - K P Mishra
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Mrinalini Singh
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Lilly Ganju
- Defence Institute of Physiology and Allied Sciences, Delhi, India
| | - Deepika Saraswat
- Defence Institute of Physiology and Allied Sciences, Delhi, India
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Sartori LF, Balamuth F. Multisystem Inflammatory Syndrome in Children: Examining Emerging Data and Identifying Key Knowledge Gaps. Pediatr Emerg Care 2022; 38:83-91. [PMID: 35100745 PMCID: PMC8855966 DOI: 10.1097/pec.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of abnormal immune response after severe acute respiratory syndrome coronavirus 2 infection that can result in organ dysfunction including severe cardiovascular compromise in children. Increased evidence supports a clinical and laboratory profile in MIS-C distinct from Kawasaki disease, with MIS-C typically occurring in older children and with more prominent gastrointestinal and neurologic symptoms, as well as increased inflammation, lymphopenia, and cardiac injury on laboratory testing. However, high-level evidence regarding best practices for treatment and long-term outcomes in MIS-C is limited.
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Affiliation(s)
- Laura F Sartori
- From the Assistant Professor and Associate Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; and Division of Pediatric Emergency Medicine and Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA
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Dilorenzo MP, Farooqi KM, Shah AM, Channing A, Harrington JK, Connors TJ, Martirosyan K, Krishnan US, Ferris A, Weller RJ, Farber DL, Milner JD, Gorelik M, Rosenzweig EB, Anderson BR. Ventricular Function and Tissue Characterization By Cardiac MRI in Children Following Hospitalization for Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Study. RESEARCH SQUARE 2022:rs.3.rs-1254952. [PMID: 35118462 PMCID: PMC8811945 DOI: 10.21203/rs.3.rs-1254952/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe life-threatening manifestation of SARS-CoV-2 infection. Acute cardiac dysfunction and resultant cardiogenic shock are common in children with MIS-C. While most children recover rapidly from acute illness, the long-term impact on the myocardium and cardiac function is unknown. Methods In this prospective study, cardiac MRI (CMR) was performed on patients <21 years of age with a history of MIS-C, 6-9 months following hospitalization. Per institutional protocol, patients with any history of LVEF<50%, persistent cardiorespiratory symptoms, or ECG abnormalities underwent clinical CMR. Research CMRs were offered to all others >10 years old. Native T1 and T2 mapping values were compared with 20 children with normal CMR examinations. Results We performed CMRs on 13 subjects at a median age of 13.6 years (interquartile range [IQR] 11.9-16.0) and a median time from hospitalization of 8.2 months (IQR 6.8-9.6). Twelve subjects displayed normal ventricular function with a median left ventricle ejection fraction (LVEF) of 57.2% (IQR 56.1-58.4) and median right ventricular (RV) EF of 53.1% (IQR 52.0-55.7). One subject had low normal EF (52%). There was normal T2 and native T1 as compared to normal controls. There was qualitatively no evidence of edema by T2 weighted imaging. One subject had late gadolinium enhancement (LGE) at the inferior insertion point and mid-ventricular inferolateral region, with normal EF, no evidence of edema or perfusion defects, and normal T1 and T2 times. When stratifying by a history of abnormal LVEF (LVEF <55%) on echocardiography, there was no difference in or parametric mapping values, though LVEF and LVEDV approached significance (p=0.06 and 0.05, respectively). Conclusions Although many children with MIS-C present acutely with cardiac dysfunction, myocardial recovery is overall excellent with minimal to no evidence of residual cardiac dysfunction or myocardial involvement. LVEF by CMR at 6-9 months among children with history of echocardiographic LV dysfunction is slightly lower, though does not meet statistical significance and is still within normal range. The long-term functional implications of this finding and the cardiac implications of MIS-C more broadly are unclear and warrant further study.
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Affiliation(s)
| | | | - Amee M Shah
- CUIMC: Columbia University Irving Medical Center
| | | | | | | | | | | | - Anne Ferris
- CUIMC: columbia University Irving Medical Center
| | | | | | | | - Mark Gorelik
- CUIMC: Columbia University Irving Medical Center
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30
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What Is New on Paediatric Echocardiography for the Diagnosis, Management and Follow-Up of the Multisystem Inflammatory Syndrome Associated with COVID-19? CHILDREN 2022; 9:children9020146. [PMID: 35204868 PMCID: PMC8869951 DOI: 10.3390/children9020146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/23/2022]
Abstract
Conventional echocardiography is an essential tool for the diagnosis, bedside management and follow-up evaluations of children with multisystem inflammatory syndrome associated with COVID-19. However, a more comprehensive echocardiographic exam, including myocardial deformation parameters, may allow early identification of subtle changes in ventricular function, provide risk stratification and, identify sub-clinical cardiac dysfunction at follow-up. Thus, myocardial deformation analysis should be routinely integrated to conventional echocardiography assessment in these patients.
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31
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Imaging findings in acute pediatric coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome in children (MIS-C). Pediatr Radiol 2022; 52:1985-1997. [PMID: 35616701 PMCID: PMC9132751 DOI: 10.1007/s00247-022-05393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022]
Abstract
The two primary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are acute coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome (MIS-C). While most pediatric cases of acute COVID-19 disease are mild or asymptomatic, some children are at risk for developing severe pneumonia. In MIS-C, children present a few weeks after SARS-CoV-2 exposure with a febrile illness that can rapidly progress to shock and multiorgan dysfunction. In both diseases, the clinical and laboratory findings can be nonspecific and present a diagnostic challenge. Thoracic imaging is commonly obtained to assist with initial workup, assessment of disease progression, and guidance of therapy. This paper reviews the radiologic findings of acute COVID-19 pneumonia and MIS-C, highlights the key distinctions between the entities, and summarizes our understanding of the role of imaging in managing SARS-CoV-2-related illness in children.
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32
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Fremed MA, Farooqi KM. Longitudinal Outcomes and Monitoring of Patients With Multisystem Inflammatory Syndrome in Children. Front Pediatr 2022; 10:820229. [PMID: 35433557 PMCID: PMC9010503 DOI: 10.3389/fped.2022.820229] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
The acute manifestations and short-term outcomes of multisystem inflammatory syndrome (MIS-C) have been extensively described; however, our understanding of the longitudinal outcomes associated with this condition continue to evolve. Here we review the existing literature on outcomes of MIS-C up to 1 year following diagnosis and summarize current published expert recommendations for management and follow up of these patients.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
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Sirico D, Basso A, Sabatino J, Reffo E, Cavaliere A, Biffanti R, Cerutti A, Castaldi B, Zulian F, Da Dalt L, Di Salvo G. OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1066-1074. [PMID: 35639926 PMCID: PMC9384104 DOI: 10.1093/ehjci/jeac096] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Aims Methods and results Conclusion
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Affiliation(s)
- D Sirico
- Corresponding author. Tel: +39 3388121632, E-mail:
| | - A Basso
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - J Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - E Reffo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cavaliere
- Institute of Radiology, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - R Biffanti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - A Cerutti
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - B Castaldi
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - F Zulian
- Pediatric Rheumatology Unit, Department for Women's and Children's Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
| | - L Da Dalt
- Pediatric Emergency Unit, Department for Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - G Di Salvo
- Pediatric and Congenital Cardiology Unit, Department for Women's and Children’s Health, University Hospital of Padova, Via Nicolò Giustiniani 2, 35128 Padua, Italy
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Liu K, Yu J, Song G. Global Myocardial Strain in Multisystem Inflammatory Syndrome in Children, Kawasaki Disease, and Healthy Children: A Network Meta-Analysis. Front Pediatr 2022; 10:848306. [PMID: 35832589 PMCID: PMC9272823 DOI: 10.3389/fped.2022.848306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 6,000 multisystem inflammatory syndrome in children (MIS-C) have been reported in the United States by November 2021. Left ventricular global myocardial strain has been proved to be one of the best evidence of the diagnostic and prognostic implications for cardiac dysfunction. The global myocardial strain change of MIS-C in the acute phase was still unclear. METHODS PubMed and other sources were searched. A network meta-analysis was conducted. MIS-C was divided into two groups according to left ventricular ejection fraction (LVEF): MIS-C with depressed ejection fraction (MIS-C dEF) and MIS-C with preserved ejection fraction (MIS-C pEF). Global longitudinal strain (GLS) and global circumferential strain (GCS) were compared among MIS-C, Kawasaki disease (KD), and healthy children. RESULTS In total, nine case-control studies were included, published between 2014 and 2021. These studies involved 107 patients with MIS-C, 188 patients with KD, and 356 healthy children. After Bayesian analysis, MIS-C dEF group was found to have a lower LVEF, higher GLS and GCS than the KD groups. Both MIS-C pEF and KD had similar GLS and GCS, which were higher than healthy controls. There was no difference of LVEF among MIS-C pEF, KD, and healthy controls. CONCLUSION MIS-C dEF was more severe than KD, both in LVEF and global myocardial strain. MIS-C pEF and KD were similar with mild impaired left ventricular myocardial strain compared with the healthy children. Global myocardial strain may be a monitoring index for MIS-C. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021264760].
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Affiliation(s)
- Kaiwei Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiahui Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Aeschlimann FA, Misra N, Hussein T, Panaioli E, Soslow JH, Crum K, Steele JM, Huber S, Marcora S, Brambilla P, Jain S, Navallas M, Giuli V, Rücker B, Angst F, Patel MD, Azarine A, Caro-Domínguez P, Cavaliere A, Di Salvo G, Ferroni F, Agnoletti G, Bonnemains L, Martins D, Boddaert N, Wong J, Pushparajah K, Raimondi F. Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study-the CARDOVID registry. J Cardiovasc Magn Reson 2021; 23:140. [PMID: 34969397 PMCID: PMC8717054 DOI: 10.1186/s12968-021-00841-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort. METHODS AND RESULTS Hundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0-13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19-47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87-23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18-21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction. CONCLUSION No CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage. CLINICAL TRIAL REGISTRATION The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.
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Affiliation(s)
- Florence A Aeschlimann
- Department of Pediatric Immunology-Hematology and Rheumatology, Hôpital Necker Enfants Malades, Paris, France
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Zucker School of Medicine, Cohen Children's Medical Center of NY, Northwell Health, New York, USA
| | | | - Elena Panaioli
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
- Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Thomas P Graham Jr, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly Crum
- Division of Pediatric Cardiology, Thomas P Graham Jr, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy M Steele
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Steffen Huber
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Simona Marcora
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Brambilla
- Radiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Supriya Jain
- Division of Pediatric Cardiology, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Maria Navallas
- Radiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Beate Rücker
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Felix Angst
- Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland
| | - Mehul D Patel
- Division of Pediatric Cardiology, University of Texas Health Science Center, Houston, TX, USA
| | - Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Francesca Ferroni
- Cardiology Department, Regina Margherita Children's Hospital, Turin, Italy
| | | | - Laurent Bonnemains
- Paediatric Cardiology, University Hospital of Strasbourg, Strasbourg, France
- ICube, Équipe MecaFlu, UMR 7357, University of Strasbourg, Strasbourg, France
| | - Duarte Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Nathalie Boddaert
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
- Institut Imagine, Paris, France
| | - James Wong
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Francesca Raimondi
- Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France.
- Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France.
- Institut Imagine, Paris, France.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France.
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Fabi M, Filice E, Biagi C, Andreozzi L, Palleri D, Mattesini BE, Rizzello A, Gabrielli L, Ghizzi C, Di Luca D, Caramelli F, De Fanti A, Lanari M. Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children: One Year after the Onset of the Pandemic in a High-Incidence Area. Viruses 2021; 13:2022. [PMID: 34696451 PMCID: PMC8541388 DOI: 10.3390/v13102022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.
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Affiliation(s)
- Marianna Fabi
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Emanuele Filice
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Carlotta Biagi
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Laura Andreozzi
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Daniela Palleri
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Bianca Elisa Mattesini
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Alessia Rizzello
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
| | - Liliana Gabrielli
- Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy;
| | - Chiara Ghizzi
- Department of Pediatrics, Maggiore Hospital, 40133 Bologna, Italy;
| | - Daniela Di Luca
- Department of Anesthesiology, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (D.D.L.); (F.C.)
| | - Fabio Caramelli
- Department of Anesthesiology, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (D.D.L.); (F.C.)
| | - Alessandro De Fanti
- Pediatrics Unit, Arcispedale Santa Maria Nuova, Via Risorgimento 80, 42123 Reggio Emilia, Italy;
| | - Marcello Lanari
- Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy; (M.F.); (C.B.); (L.A.); (D.P.); (B.E.M.); (A.R.); (M.L.)
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