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. 2021 Nov 29:26:113.
doi: 10.4103/jrms.JRMS_1195_20. eCollection 2021.

Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents

Vladislav Vukomanovic  1   2 , Stasa Krasic  1 , Sergej Prijic  1   2 , Gordana Petrovic  3 , Sanja Ninic  1 , Sasa Popovic  1 , Ivana Cerovic  1 , Snezana Ristic  4 , Dejan Nesic  5
Affiliations

Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents

Vladislav Vukomanovic et al. J Res Med Sci. .

Abstract

Background: In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported.

Materials and methods: A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed.

Results: Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms.

Conclusions: With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period.

Keywords: Adolescents; SARS-CoV-2; multisystem inflammatory syndrome in children; myocarditis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Changes of laboratory and echocardiography parameters during hospitalization. Abbreviations: CRP = C-reactive protein; WBC = White blood cell; Hob = Hemoglobin; Na = sodium; Cr = Creatinine; ALT - Alanine transaminase; LDH - Lactate dehydrogenase; cTnI = Cardiac troponin I; NT-proBNP - N-terminal (NT)-pro hormone B-type natriuretic peptide; LV = Left ventricle, EDD = End-diastolic diameter; ESD = End-systolic diameter; IVSd = Interventricular septum diastolic diameter; PWd = Posterior wall diastolic diameter; EF = Ejection fraction; FS = Fractional shortening
See this image and copyright information in PMC

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