CV Findings of COVID-19 Multisystem Inflammatory Syndrome in Children

Quick Takes

  • Cardiac involvement is common in children with multisystem inflammatory syndrome (MIS-C) associated with the COVID-19 pandemic.
  • However, mortality in children with MIS-C is uncommon despite multisystem involvement, very elevated inflammatory markers, and need for intensive care support.
  • Children with MIS-C should be monitored for shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation, which are the four most common cardiovascular complications in this study cohort.

Study Questions:

What are the cardiovascular (CV) clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome (MIS-C) associated with coronavirus disease 2019 (COVID-19) infection?

Methods:

The investigators conducted a real-time internet-based survey endorsed by the Association for European Pediatric and Congenital Cardiologists (AEPC) Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Inclusion criteria were children 0-18 years old, admitted to the hospital between February 1 and June 6, 2020, with diagnosis of an inflammatory syndrome and acute CV complications.

Results:

A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were males. The most common CV complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients and a vast majority of children had raised cardiac troponin (cTnT) when checked. The biochemical markers of inflammation were raised in the majority of patients on admission: elevated C-reactive protein (CRP), serum ferritin, procalcitonin, N-terminal pro–B-type natriuretic peptide (NT-proBNP), interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and need for intensive care support (p < 0.05). Polymerase chain reaction (PCR) for SARS-CoV-2 was positive in 33.6%, while IgM and IgG antibodies were positive in 15.7% and IgG 43.6% of cases, respectively when checked. One child died in the study cohort.

Conclusions:

The authors concluded that cardiac involvement is common in children with multisystem inflammatory syndrome associated with the COVID-19 pandemic.

Perspective:

This multicenter pan-European survey reports that cardiac involvement is common in MIS-C associated with the COVID-19 pandemic. A majority of children with MIS-C have significantly raised levels of NT-proBNP, ferritin, D-dimers, and cTnT in addition to high CRP and procalcitonin levels. However, mortality in children with MIS-C is uncommon despite multisystem involvement, very elevated inflammatory markers, and need for intensive care support. Finally, children with MIS-C should be monitored for shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation, which are the four most common CV complications in this study cohort.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pericardial Disease, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Arrhythmias, Cardiac, Coronavirus Infections, COVID-19, C-Reactive Protein, Diagnostic Imaging, Dilatation, Ferritins, Heart Failure, Inflammation, Interleukin-6, Natriuretic Peptide, Brain, Pediatrics, Pericardial Effusion, Primary Prevention, severe acute respiratory syndrome coronavirus 2, Shock, Cardiogenic, Stroke Volume, Troponin T, Ventricular Function, Left


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