Cardiac dysfunction in Multisystem Inflammatory Syndrome in Children: An Italian single-center study.
COVID-19
Cardiac
Children
Heart
Multisystem inflammatory syndrome
Journal
Italian journal of pediatrics
ISSN: 1824-7288
Titre abrégé: Ital J Pediatr
Pays: England
ID NLM: 101510759
Informations de publication
Date de publication:
08 Feb 2022
08 Feb 2022
Historique:
received:
13
10
2021
accepted:
30
11
2021
entrez:
9
2
2022
pubmed:
10
2
2022
medline:
11
2
2022
Statut:
epublish
Résumé
Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients. A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge. Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7-13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients. Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.
Sections du résumé
BACKGROUND
BACKGROUND
Multisystem inflammatory syndrome in children (MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is mainly evident as acute myocardial dysfunction in MIS-C. The aim of this study was to describe the cardiac dysfunction in patients with MIS-C, defining the role of severity in the clinical presentations and outcomes in a single cohort of pediatric patients.
METHODS
METHODS
A single-center retrospective study on patients diagnosed with MIS-C, according to the Center for Disease Control and Prevention (CDC) definition, and referred to Vittore Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were managed according to a local approved protocol. According to the admission cardiac left ventricular ejection fraction (LVEF), the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥45%). Pre-existing, clinical, and laboratory factors were assessed for evaluating outcomes at discharge.
RESULTS
RESULTS
Thirty-two patients were considered. Cardiac manifestations of MIS-C were reported in 26 patients (81%). Group A included 10 patients (9 M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15 M/7 M, aged 9 years [IQR 7-13]). Significant differences were noted among clinical presentations (shock, diarrhea, intensive care unit admission), laboratory markers (leucocytes, neutrophils, and protein C-reactive), and cardiac markers (troponin T and N-terminal pro B-type Natriuretic Peptide) between the groups, with higher compromission in Group A. We found electrocardiogram anomalies in 14 patients (44%) and rhythm alterations in 3 patients (9%), without differences between groups. Mitral regurgitation and coronary involvement were more prevalent in group A. Total length of hospital stay and cardiac recovery time were not statistically different between groups. A recovery of cardiac functioning was reached in all patients.
CONCLUSION
CONCLUSIONS
Despite significant differences in clinical presentations and need for intensive care, all of the MIS-C patients with significant cardiac involvement in this study completely recovered. This suggests that the heart is an involved organ and did not influence prognosis if properly treated and supported in the acute phase.
Identifiants
pubmed: 35135600
doi: 10.1186/s13052-021-01189-z
pii: 10.1186/s13052-021-01189-z
pmc: PMC8822778
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
25Informations de copyright
© 2021. The Author(s).
Références
Int J Rheum Dis. 2022 Jan;25(1):27-31
pubmed: 34750969
N Engl J Med. 2020 Jul 23;383(4):334-346
pubmed: 32598831
Pediatr Crit Care Med. 2021 Mar 1;22(3):e178-e191
pubmed: 33003176
J Am Soc Echocardiogr. 2011 Jan;24(1):60-74
pubmed: 21074965
Int J Cardiol Heart Vasc. 2021 Apr;33:100764
pubmed: 33778151
Pediatr Int. 2010 Dec;52(6):876-82
pubmed: 21166948
Circ Heart Fail. 2020 Jul;13(7):e006570
pubmed: 32507024
JAMA Netw Open. 2021 Jun 1;4(6):e2116420
pubmed: 34110391
Curr Pediatr Rep. 2021 Oct 19;:1-10
pubmed: 34692237
J Am Heart Assoc. 2021 Aug 17;10(16):e021428
pubmed: 34365798
Circulation. 2021 Jan 5;143(1):21-32
pubmed: 33166189
Pediatr Infect Dis J. 2021 Nov 1;40(11):e400-e406
pubmed: 34382615
Lancet. 2020 May 23;395(10237):1607-1608
pubmed: 32386565
J Pediatr Endocrinol Metab. 2020 May 22;33(6):785-791
pubmed: 32441670
J Infect Public Health. 2021 Apr;14(4):484-494
pubmed: 33743370
Dela J Public Health. 2020 Jul 01;6(2):36-39
pubmed: 34467106
J Pediatr. 2021 Jul;234:27-32.e2
pubmed: 33358846
Lancet. 2020 Jun 6;395(10239):1771-1778
pubmed: 32410760
JAMA. 2021 Mar 2;325(9):855-864
pubmed: 33523115
Ital J Pediatr. 2021 Feb 8;47(1):24
pubmed: 33557873
JAMA. 2021 Mar 16;325(11):1074-1087
pubmed: 33625505
Circulation. 2021 Jan 5;143(1):78-88
pubmed: 33166178
Minerva Pediatr (Torino). 2021 Jun;73(3):203-208
pubmed: 33305919
Lancet Child Adolesc Health. 2021 May;5(5):323-331
pubmed: 33711293
Curr Pediatr Rep. 2021;9(4):93-103
pubmed: 34703656
J Pediatr. 2020 Nov;226:45-54.e1
pubmed: 32768466
Front Immunol. 2021 Feb 26;12:632890
pubmed: 33732254
Curr Cardiol Rep. 2021 Oct 1;23(11):168
pubmed: 34599465
Circulation. 2020 Aug 4;142(5):429-436
pubmed: 32418446
J Am Soc Echocardiogr. 2010 May;23(5):465-95; quiz 576-7
pubmed: 20451803
Children (Basel). 2020 Jul 01;7(7):
pubmed: 32630212