Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 20;22(8):896-903.
doi: 10.1093/ehjci/jeaa212.

Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19

Paraskevi Theocharis  1 , James Wong  1 , Kuberan Pushparajah  1   2 , Sujeev K Mathur  1 , John M Simpson  1 , Emma Pascall  1 , Aoife Cleary  1 , Kirsty Stewart  1 , Kaitav Adhvaryu  1 , Alex Savis  1 , Saleha R Kabir  1 , Mirasol Pernia Uy  1 , Hannah Heard  1 , Kelly Peacock  1 , Owen Miller  1   3
Affiliations

Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19

Paraskevi Theocharis et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement.

Methods and results: Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score -0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients.

Conclusions: Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.

Keywords: COVID-19; Hyper-inflammatory syndrome; Kawasaki; MIS-C; PIMS-TS; SARS-CoV-2.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Long-axis parasternal view of the left ventricle from the same patient as shown in Supplementary material online, Video 1, demonstrating the increased echogenicity of the interventricular septum (collection of bright spots) and very bright pericardium.
Figure 2
Figure 2
Short-axis view of the heart at the level of the aortic valve on CT and echocardiogram showing diffuse ectatic changes in the left main coronary artery (LMCA) and left anterior descending (LAD) artery. The circumflex artery origin can just be seen coming off the LMCA and is ectatic in configuration.
Figure 3
Figure 3
MRI: short axis view of the left ventricle showing late gadolinium enhancement imaging (indicated by arrow) of a transmural myocardial infarction.
See this image and copyright information in PMC

References

    1. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F, Brierley J, McDougall M, Carter M, Tremoulet A, Shimizu C, Herberg J, Burns JC, Lyall H, Levin M; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;doi: 10.1001/jama.2020.10369. - PMC - PubMed
    1. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P.. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607–1608. - PMC - PubMed
    1. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, Bonanomi E, D’Antiga L. An. outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020;395:1771–1778. - PMC - PubMed
    1. Belhadjer Z, Meot M, Bajolle F, Khraiche D, Legendre A, Abakka S, Auriau J, Grimaud M, Oualha M, Beghetti M, Wacker J, Ovaert C, Hascoet S, Selegny M, Malekzadeh-Milani S, Maltret A, Bosser G, Giroux N, Bonnemains L, Bordet J, Di Filippo S, Mauran P, Falcon-Eicher S, Thambo JB, Lefort B, Moceri P, Houyel L, Renolleau S, Bonnet D.. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation 2020;doi: 10.1161/CIRCULATIONAHA.120.048360. - PubMed
    1. Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG, Jyothish D, Kanthimathinathan HK, Welch SB, Hackett S, Al-Abadi E, Scholefield BR, Chikermane A.. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr Cardiol 2020;doi: 10.1007/s00246-020-02391-2. - PMC - PubMed

Publication types

LinkOut - more resources