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Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

Part of: Echocardiography

Published online by Cambridge University Press:  05 August 2021

Ashraf S. Harahsheh Open the ORCID record for Ashraf S. Harahsheh [Opens in a new window] ,
Anita Krishnan Open the ORCID record for Anita Krishnan [Opens in a new window] ,
Roberta L. DeBiasi ,
Laura J. Olivieri ,
Christopher Spurney ,
Mary T. Donofrio ,
Russell R. Cross ,
Matthew P. Sharron ,
Lowell H. Frank  and
Charles I. Berul
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Ashraf S. Harahsheh*
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Anita Krishnan
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Roberta L. DeBiasi
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Microbiology, Immunology and Tropical Medicine, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Infectious Diseases, Children’s National Hospital, Washington, DC, USA
Laura J. Olivieri
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Christopher Spurney
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Mary T. Donofrio
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Russell R. Cross
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Matthew P. Sharron
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Critical Care Medicine, Children’s National Hospital, Washington, DC, USA
Lowell H. Frank
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Charles I. Berul
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Adam Christopher
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Niti Dham
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
Hemalatha Srinivasalu
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Rheumatology, Children’s National Hospital, Washington, DC, USA
Tova Ronis
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Rheumatology, Children’s National Hospital, Washington, DC, USA
Karen L. Smith
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Hospitalist Medicine, Children’s National Hospital, Washington, DC, USA
Jaclyn N. Kline
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Emergency Medicine, Children’s National Hospital, Washington, DC, USA
Kavita Parikh
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Hospitalist Medicine, Children’s National Hospital, Washington, DC, USA
David Wessel
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
James E. Bost
Affiliation:
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, USA
Sarah Litt
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Ashley Austin
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Jing Zhang
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Craig A. Sable
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA
*
Author for correspondence: Dr A. S. Harahsheh, MD, Department of Pediatrics, George Washington University School of Medicine & Health Sciences; Division of Cardiology, Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC20010, USA. Tel: +202 476 2020; Fax: +202 476 5700. E-mail: aharahsh@childrensnational.org
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Abstract

Background:

A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic.

Objectives:

To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children.

Methods:

Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum.

Results:

Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04).

Conclusion:

Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

Keywords

Paediatric multisystem inflammatory syndrome temporally associated with 2019 coronavirus diseasemulti-system inflammatory syndrome in children2019 coronavirus disease pandemicpaediatric cardiologymyocarditiscoronary artery
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 718 - 726
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

†

The online version of this article has been updated since original publication. A notice detailing the changes has also been published.

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