Israel Valverde1, Yogen Singh2, Joan Sanchez-de-Toledo3, Paraskevi Theocharis4, Ashish Chikermane5, Sylvie Di Filippo6, Beata Kuciñska7, Savina Mannarino8, Amalia Tamariz-Martel9, Federico Gutierrez-Larraya10, Giridhar Soda11, Kristof Vandekerckhove12, Francisco Gonzalez-Barlatay13, Colin Joseph McMahon14, Simona Marcora15, Carlo Pace Napoleone16, Phuoc Duong17, Giulia Tuo18, Antigoni Deri19, Gauri Nepali20, Maria Ilina21, Paolo Ciliberti22, Owen Miller23. 1. Department of Pediatric Cardiology and Pediatric Intensive Care, Hospital Infantil Virgen del Rocio, Institute of Biomedicine IBIS, CIBER-CV, Seville, Spain (I.V.). 2. Department of Pediatrics - Pediatric Cardiology / Neonatology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, UK (Y.S.). 3. Department of Cardiology, Hospital Sant Joan de Deu, Barcelona, Spain (J.S.-d.-T.). 4. Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, UK (I.V., P.T., O.M.). 5. Birmingham Children's Hospital, UK (A.C.). 6. Department of Paediatric Cardiology and Paediatric Intensive Care Unit, University of Lyon Medical Center, France (S.D.F.). 7. Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Poland (B.K.). 8. Hospital Vittore Buzzi-Asst Fbf Sacco, Milano, Italy (S.M.). 9. Department of Paediatric Cardiology and Paediatric Intensive Care Unit, Hospital Infantil Universitario Niño Jesus, Madrid, Spain (A.T.-M.). 10. Department of Paediatric Cardiology, Hospital La Paz, Madrid, Spain (F.G.-L.). 11. Paediatric Cardiology, Royal Manchester Childrens Hospital, UK (G.S.). 12. Department of Paediatric Cardiology. Ghent University Hospital, Belgium (K.V.). 13. Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, UK (F.G.B.). 14. Department of Paediatric Cardiology and Paediatric Infectious Disease, CHI, Crumlin, Dublin, Ireland (C.J.M.). 15. Department of Pediatric Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy (S.A.M.). 16. Pediatric Cardiac Surgery, Regina Margherita Children's Hospital, Torino, Italy (C.P.N.). 17. Department of Paediatric Cardiology and Paediatric Intensive Care Unit, Alder Hey Children's Hospital Liverpool, UK (P.D.). 18. Paediatric Cardiology and Pediatric Rheumatology Clinic, IRCCS Giannina Gaslini Institute, Genoa, Italy (G.T.). 19. Department of Paediatric Cardiology and Paediatric Intensive Care Unit, Leeds Children's Hospital, UK (A.D.). 20. Department of Paediatric Cardiology, East Midland Congenital heart Centre, Glenfield Hospital, Leicester, UK (G.N.). 21. Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK (M.I.). 22. Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital IRCSS, Rome, Italy (P.C.). 23. School of Biomedical Engineering & Imaging Sciences and Department of Women and Children's Health, Faculty of Life Science and Medicine, King's College London, King's Health Partners, St Thomas' Hospital, UK (I.V., O.M.).
Abstract
BACKGROUND: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. METHODS: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. 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 boys. The most common cardiovascular 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 when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. CONCLUSIONS: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.
BACKGROUND: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. METHODS: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. 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 boys. The most common cardiovascular 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 when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. CONCLUSIONS: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.
Authors: Dongngan T Truong; Felicia L Trachtenberg; Gail D Pearson; Audrey Dionne; Matthew D Elias; Kevin Friedman; Kerri H Hayes; Lynn Mahony; Brian W McCrindle; Matthew E Oster; Victoria Pemberton; Andrew J Powell; Mark W Russell; Lara S Shekerdemian; Mary Beth Son; Michael Taylor; Jane W Newburger Journal: Am Heart J Date: 2021-08-19 Impact factor: 4.749
Authors: Jessica Flood; Joseph Shingleton; Emma Bennett; Brodie Walker; Zahin Amin-Chowdhury; Godwin Oligbu; Jacob Avis; Richard M Lynn; Peter Davis; Tara Bharucha; Clare E Pain; Deepthi Jyothish; Elizabeth Whittaker; Buvana Dwarakanathan; Rachael Wood; Christopher Williams; Olivia Swann; Malcolm G Semple; Mary E Ramsay; Christine E Jones; Athimalaipet V Ramanan; Nick Gent; Shamez N Ladhani Journal: Lancet Reg Health Eur Date: 2021-03-22