Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-28T14:07:04.863Z Has data issue: false hasContentIssue false

Echocardiographic findings in non-hospitalised children and adolescents following acute COVID-19

Published online by Cambridge University Press:  10 August 2023

Amanda M. McIntosh*
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA Department of Paediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
Anmol Goyal
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
Carol Moser-Dungan
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA
Brian Harvey
Affiliation:
Department of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA Division of Sports Medicine, Children’s Mercy Kansas City, Kansas City, MO, USA
Howard J. Heching
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA Department of Paediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
Doaa G. Aly
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA Department of Paediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
Nitin Madan
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA Department of Paediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
Daniel Forsha
Affiliation:
Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, USA Department of Paediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
*
Corresponding author: A.M. McIntosh; Email: ammcintosh@cmh.edu

Abstract

Background:

Although COVID-19 is known to have cardiac effects in children, seen primarily in severe disease, more information is needed about the cardiac effects following COVID-19 in non-hospitalised children and adolescents during recovery. This study aims to compare echocardiographic markers of cardiac size and function of children following acute COVID-19 with those of healthy controls.

Methods:

This single-centre retrospective case–control study compared 71 cases seen in cardiology clinic following acute COVID-19 with 33 healthy controls. Apical left ventricle, apical right ventricle, and parasternal short axis at the level of the papillary muscles were analysed to measure ventricular size and systolic function. Strain was analysed on vendor-independent software. Statistical analysis was performed using t-test, chi-square, Wilcoxon rank sum, and regression modelling as appropriate (p < 0.05 significant).

Results:

Compared to controls, COVID-19 cases had slightly higher left ventricular volumes and lower left ventricular ejection fraction and right ventricular fractional area change that remained within normal range. There were no differences in right or left ventricular longitudinal strain between the two groups. Neither initial severity nor persistence of symptoms after diagnosis predicted these differences.

Conclusions:

Echocardiographic findings in children and adolescents 6 weeks to 3 months following acute COVID-19 not requiring hospitalisation were overall reassuring. Compared to healthy controls, the COVID-19 group demonstrated mildly larger left ventricular size and lower conventional measures of biventricular systolic function that remained within the normal range, with no differences in biventricular longitudinal strain. Future studies focusing on longitudinal echocardiographic assessment of patients following acute COVID-19 are needed to better understand these subtle differences in ventricular size and function.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cantarutti, N, Battista, V, Adorisio, R, et al. Cardiac manifestations in children with SARS-COV-2 infection: 1-year pediatric multicenter experience. Children 2021; 8: 717. DOI: 10.3390/CHILDREN8080717.Google Scholar
Baggish, A, Drezner, JA, Kim, J, Martinez, M, Prutkin, JM. Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes. Br J Sports Med 2020; 54: 11301131. DOI: 10.1136/bjsports-2020-102516.Google Scholar
Kim, JH, Levine, BD, Phelan, D, et al. Coronavirus disease 2019 and the athletic heart: emerging perspectives on pathology, risks, and return to play. JAMA Cardiol 2020; 6: 219227. DOI: 10.1001/jamacardio.2020.5890.Google Scholar
Phelan, D, Kim, JH, Elliott, MD, et al. Screening of potential cardiac involvement in competitive athletes recovering from COVID-19: an expert consensus statement. JACC Cardiovasc Imaging 2020; 13: 26352652. DOI: 10.1016/j.jcmg.2020.10.005.Google Scholar
Martinez, MW, Tucker, AM, Bloom, OJ, et al. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening. JAMA Cardiol 2021; 6: 745752. DOI: 10.1001/JAMACARDIO.2021.0565.Google Scholar
Moulson, N, Petek, BJ, Drezner, JA, et al. SARS-CoV-2 cardiac involvement in young competitive athletes. Circulation 2021; 144: 256266. DOI: 10.1161/CIRCULATIONAHA.121.054824.Google Scholar
Cavigli, L, Frascaro, F, Turchini, F, et al. A prospective study on the consequences of SARS-CoV-2 infection on the heart of young adult competitive athletes: implications for a safe return-to-play. Int J Cardiol 2021; 336: 130136. DOI: 10.1016/J.IJCARD.2021.05.042.Google Scholar
Chowdhury, D, Fremed, MA, Dean, P, et al. Return to activity after SARS-coV-2 infection: cardiac clearance for children and adolescents. Sports Health 2021; XX: 16. DOI: 10.1177/19417381211039746.Google Scholar
Brito, D, Meester, S, Yanamala, N, et al. High prevalence of pericardial involvement in college student athletes recovering from COVID-19. JACC Cardiovasc Imaging. 2020; 14: 541555. DOI: 10.1016/j.jcmg.2020.10.023.Google Scholar
Seidel, F, Kuehne, T, Kelle, S, et al. Cardiovascular magnetic resonance findings in non-hospitalized paediatric patients after recovery from COVID-19. ESC Heart Fail 2021; 8: 55835588. DOI: 10.1002/EHF2.13678.Google Scholar
Moulson, N, Gustus, SK, Scirica, C, et al. Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19. Br J Sports Med 2022; 56: 927–932. DOI: 10.1136/BJSPORTS-2021-105157.Google Scholar
Committee, W, Gluckman, TJ, Bhave, NM, et al. ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American college of cardiology solution set oversight committee. J Am Coll Cardiol 2022; 79: 17171756. DOI: 10.1016/J.JACC.2022.02.003.Google Scholar
Sirico, D, di Chiara, C, Costenaro, P, et al. Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-coV-2 infection. Eur Heart J Cardiovasc Imaging 2021; 23: 10831089. DOI: 10.1093/EHJCI/JEAB127.Google Scholar
Erol, N, Alpinar, A, Erol, C, Sari, E, Alkan, K. Intriguing new faces of covid-19: persisting clinical symptoms and cardiac effects in children. Cardiol Young 2021; 32: 11091. DOI: 10.1017/S1047951121003693.Google Scholar
v., Raveendran A, Jayadevan, R, Sashidharan S.Long, COVID. An overview. Diabetes Metab Syndr 2021; 15: 869875. DOI: 10.1016/J.DSX.2021.04.007.Google Scholar
Fernández-de-las-Peñas, C. Long COVID: current definition. Infection 2022; 50: 285286. DOI: 10.1007/S15010-021-01696-5.CrossRefGoogle ScholarPubMed
Heching, HJ, Goyal, A, Harvey, B, et al. Electrocardiographic changes in non-hospitalised children with COVID-19. Cardiol Young 2022; 32: 17. DOI: 10.1017/S1047951121005138.Google Scholar
Lai, WW, Geva, T, Shirali, GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the task force of the pediatric council of the American society of echocardiography. J Am Soc Echocardiogr 2006; 19: 14131430. DOI: 10.1016/j.echo.2006.09.001.Google Scholar
Colan, SD. Normal echocardiographic values for cardiovascular structures. Echocardiograph Pediatr Congenit Heart Dis 2016: 883901. DOI: 10.1002/9781118742440.app1.Google Scholar
Voigt, JU, Pedrizzetti, G, Lysyansky, P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 111. DOI: 10.1093/EHJCI/JEU184.Google Scholar
Anavekar, NS, Gerson, D, Skali, H, Kwong, RY, Kent Yucel, E, Solomon, SD. Two-dimensional assessment of right ventricular function: an echocardiographic-MRI correlative study. Echocardiography 2007; 24: 452456. DOI: 10.1111/J.1540-8175.2007.00424.X.Google Scholar
Halliday, BP, Senior, R, Pennell, DJ. Assessing left ventricular systolic function: from ejection fraction to strain analysis. Eur Heart J 2021; 42: 789797. DOI: 10.1093/eurheartj/ehaa587.Google Scholar
McEachern, WA, Coburn, Jr. GW, Jonathan, SH, Parra, DA. Echocardiographic findings in adolescents presenting for sports clearance following COVID-19. Pediatrics 2022; 149: 326.Google Scholar