tetano
Editor, Senior Moderator
Front Cardiovasc Med
. 2023 Jan 25;10:1115389.
doi: 10.3389/fcvm.2023.1115389. eCollection 2023.
Cardiac MRI with late gadolinium enhancement shows cardiac involvement 3-6 months after severe acute COVID-19 similar to or worse than PIMS
Lyubov A Chochkova-Bukova[SUP] 1 [/SUP], Dominik Funken[SUP] 2 [/SUP], Mila Bukova[SUP] 3 [/SUP], Kamelia Z Genova[SUP] 4 [/SUP], Sadika Ali[SUP] 1 [/SUP], Snezhana Stoencheva[SUP] 1 [/SUP], Ivanka N Paskaleva[SUP] 1 [/SUP], Zeira Halil[SUP] 1 [/SUP], Ivelina Neicheva[SUP] 1 [/SUP], Anastasia Shishmanova[SUP] 1 [/SUP], Kristina Stefanova Kelly[SUP] 1 [/SUP], Ivan S Ivanov[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) in children is rarely severe. However, severe courses occur, especially in the presence of risk factors. A minority of children develop pediatric inflammatory multisystem syndrome (PIMS) with substantial morbidity. While the importance of cardiac involvement after PIMS is well established, its role after severe acute COVID-19 remains unclear. We aim to compare cardiac sequelae of children after severe acute COVID-19 using cardiac MRI and compare them with patients after PIMS.
Methods: For this prospective cohort study, we recruited patients with acute COVID or PIMS in a single center. Clinical follow-up, lab work, ECG, and echocardiography were done within 2 days after disease onset and 3-6 months after discharge. At the last visit 3-6 months later, cardiac MRI (CMR) with late gadolinium enhancement (LGE) was performed to evaluate cardiac sequelae and compare both groups.
Results: Data were obtained from n = 14 patients with PIMS and n = 7 patients with severe acute COVID-19. At the start of the respective disease, left ventricular (LV) ejection fraction was reduced in seven patients with PIMS but none in the acute COVID-19 group. Transient mitral valve insufficiency was present in 38% of patients, of whom PIMS accounted for 7/8 cases. Eight patients (38%) with PIMS presented coronary artery abnormalities, with normalization in 7/8 patients. A significant decrease in LV mass index 3-6 months after disease onset was observed in both groups. MRI follow-up revealed non-ischemic myocardial pattern of LGE in 12/21 patients- in all (6/6) after severe acute COVID-19 and in less than half (6/14) after PIMS. Normal body weight-adjusted stroke volumes and end-diastolic volumes were found in 20/21 patients.
Conclusions: We show that children suffering from severe acute COVID-19 have a similar, or worse, cardiac risk profile as patients with PIMS. Both patient groups should therefore receive close pediatric cardiac follow-up examinations. Cardiac MRI is the technique of choice, as most patients presented with delayed LGE as a sign of persistent cardiac injury despite normalization of laboratory and echocardiographic findings.
Keywords: Multisystem Inflammatory Syndrome in Children (MIS-C); SARS-CoV2; cardiac imaging; echocardiography; heart involvement.
. 2023 Jan 25;10:1115389.
doi: 10.3389/fcvm.2023.1115389. eCollection 2023.
Cardiac MRI with late gadolinium enhancement shows cardiac involvement 3-6 months after severe acute COVID-19 similar to or worse than PIMS
Lyubov A Chochkova-Bukova[SUP] 1 [/SUP], Dominik Funken[SUP] 2 [/SUP], Mila Bukova[SUP] 3 [/SUP], Kamelia Z Genova[SUP] 4 [/SUP], Sadika Ali[SUP] 1 [/SUP], Snezhana Stoencheva[SUP] 1 [/SUP], Ivanka N Paskaleva[SUP] 1 [/SUP], Zeira Halil[SUP] 1 [/SUP], Ivelina Neicheva[SUP] 1 [/SUP], Anastasia Shishmanova[SUP] 1 [/SUP], Kristina Stefanova Kelly[SUP] 1 [/SUP], Ivan S Ivanov[SUP] 1 [/SUP]
Affiliations
- PMID: 36760557
- PMCID: PMC9905637
- DOI: 10.3389/fcvm.2023.1115389
Abstract
Background: Coronavirus disease 2019 (COVID-19) in children is rarely severe. However, severe courses occur, especially in the presence of risk factors. A minority of children develop pediatric inflammatory multisystem syndrome (PIMS) with substantial morbidity. While the importance of cardiac involvement after PIMS is well established, its role after severe acute COVID-19 remains unclear. We aim to compare cardiac sequelae of children after severe acute COVID-19 using cardiac MRI and compare them with patients after PIMS.
Methods: For this prospective cohort study, we recruited patients with acute COVID or PIMS in a single center. Clinical follow-up, lab work, ECG, and echocardiography were done within 2 days after disease onset and 3-6 months after discharge. At the last visit 3-6 months later, cardiac MRI (CMR) with late gadolinium enhancement (LGE) was performed to evaluate cardiac sequelae and compare both groups.
Results: Data were obtained from n = 14 patients with PIMS and n = 7 patients with severe acute COVID-19. At the start of the respective disease, left ventricular (LV) ejection fraction was reduced in seven patients with PIMS but none in the acute COVID-19 group. Transient mitral valve insufficiency was present in 38% of patients, of whom PIMS accounted for 7/8 cases. Eight patients (38%) with PIMS presented coronary artery abnormalities, with normalization in 7/8 patients. A significant decrease in LV mass index 3-6 months after disease onset was observed in both groups. MRI follow-up revealed non-ischemic myocardial pattern of LGE in 12/21 patients- in all (6/6) after severe acute COVID-19 and in less than half (6/14) after PIMS. Normal body weight-adjusted stroke volumes and end-diastolic volumes were found in 20/21 patients.
Conclusions: We show that children suffering from severe acute COVID-19 have a similar, or worse, cardiac risk profile as patients with PIMS. Both patient groups should therefore receive close pediatric cardiac follow-up examinations. Cardiac MRI is the technique of choice, as most patients presented with delayed LGE as a sign of persistent cardiac injury despite normalization of laboratory and echocardiographic findings.
Keywords: Multisystem Inflammatory Syndrome in Children (MIS-C); SARS-CoV2; cardiac imaging; echocardiography; heart involvement.