Cardiac Manifestation in Multisystem Inflammatory Syndrome in Children during Global SARS-CoV-2 Pandemic

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Cardiology".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 13015

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Department of Pediatric Cardiology, Children’s of Mississippi, University of Mississippi Medical Center, Jackson, MS 39211, USA
Interests: pediatric cardiology; pediatric cardiomyopathy; heart failure; mechanical circulatory support; heart transplantation; exercise testing
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Special Issue Information

Dear Colleagues,

A pediatric multisystem inflammatory syndrome (MIS-C), with side effects ranging from fever and inflammation to myocardial injury, shock, and the coronary development of artery aneurysms, which presents and progresses similarly to patients with Kawasaki Disease and KD Shock syndrome, has been reported following SARS-CoV-2 infection. Vaccine trials are ongoing; current studies include children as young as 12 years of age. It is critical that pediatric patients of all ages be included in trials as quickly as possible, including those who belong to racial, ethnic, and cultural groups that have been disproportionately affected by the pandemic or who have underlying conditions that place them at increased risk for developing severe COVID-19 infection.

To date, there have been more than 103 million confirmed cases of coronavirus 2019 (COVID-19) disease worldwide, with more than 2.3 million deaths. The COVID-19 pandemic has had a catastrophic impact on global health. Children are less severely affected but not immune to SARS-CoV-2. In this context, it is important to study diverse cardiac involvement due to SARS-CoV-2 infection and highlight the significant variability of COVID-19 presentations in children.

Dr. Bibhuti B. Das
Guest Editor

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Keywords

  • SARS-CoV-2 infection
  • COVID-19
  • inflammatory cardiomyopathy
  • multisystem inflammatory syndrome in children

Published Papers (4 papers)

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Research

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11 pages, 555 KiB  
Article
Advanced Echocardiographic Analysis in Medium-Term Follow-Up of Children with Previous Multisystem Inflammatory Syndrome
by Massimo Garbin, Irene Raso, Alessandra Piersanti, Laura Gianolio, Annalisa De Silvestri, Valeria Calcaterra, Carla G. Corti, Luisa F. Nespoli, Sara Santacesaria, Giulia Fini, Dario Dilillo, Gianvincenzo Zuccotti and Savina Mannarino
Children 2022, 9(6), 917; https://doi.org/10.3390/children9060917 - 18 Jun 2022
Cited by 9 | Viewed by 1808
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were [...] Read more.
Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory disease related to SARS-CoV2 infection, with frequent cardiovascular involvement in the acute setting. The aim of the study was to evaluate the cardiac function at 6 months. Thirty-two patients diagnosed with MIS-C were enrolled and underwent advanced echocardiogram at discharge and at 6 months. According to the left ventricular ejection fraction (LVEF) at admission, the patients were divided into group A (LVEF < 45%) and group B (LVEF ≥ 45%) and the follow-up results were compared. At discharge, all patients had normal LV and RV systolic function (LVEF 61 ± 4.4%, LV global longitudinal strain −22.1%, TAPSE 20.1mm, s’ wave 0.13m/s, RV free wall longitudinal strain −27.8%) with normal LV diastolic function (E/A 1.5, E/e’ 5.7, and left atrial strain 46.5%) and no significant differences at 6 months. Compared to group B, the group A patients showed a reduced, even if normal, LV global longitudinal strain at discharge (−21.1% vs. −22.6%, p-value 0.02), but the difference was no longer significant at the follow-up. Patients with MIS-C can present with depressed cardiac function, but if treated, the cardiac function recovered without late onset of cardiac disease. This favorable result was independent of the severity of acute LV dysfunction. Full article
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8 pages, 665 KiB  
Article
Cardiac Manifestations in Children with SARS-COV-2 Infection: 1-Year Pediatric Multicenter Experience
by Nicoletta Cantarutti, Virginia Battista, Rachele Adorisio, Marianna Cicenia, Claudia Campanello, Elisa Listo, Andrea Campana, Gianluca Trocchio and Fabrizio Drago
Children 2021, 8(8), 717; https://doi.org/10.3390/children8080717 - 23 Aug 2021
Cited by 24 | Viewed by 5044
Abstract
Since the spread of COVID-19, pediatric patients were initially considered less affected by SARS-COV-2, but current literature reported subsets of children with multisystem inflammatory syndrome (MIS-C). This study aims to describe the cardiac manifestation of SARS-COV-2 infection in a large cohort of children [...] Read more.
Since the spread of COVID-19, pediatric patients were initially considered less affected by SARS-COV-2, but current literature reported subsets of children with multisystem inflammatory syndrome (MIS-C). This study aims to describe the cardiac manifestation of SARS-COV-2 infection in a large cohort of children admitted to two Italian pediatric referral centers. Between March 2020 and March 2021, we performed a cardiac evaluation in 294 children (mean age 9 ± 5.9 years, male 60%) with active or previous SARS-COV-2 infection. Twenty-six showed ECG abnormalities: 63 repolarization anomalies, 13 Long QTc, five premature ventricular beats, two non-sustained ventricular tachycardia, and one atrial fibrillation. In total, 146 patients underwent cardiac biomarkers: NT-proBNP was elevated in 57, troponin in 34. An echocardiogram was performed in 98, showing 54 cardiac anomalies: 27 left-ventricular dysfunction, 42 pericarditis, 16 coronaritis. MIS-C was documented in 46 patients (mean age 9 ± 4.8 years, male 61%) with cardiac manifestations in 97.8%: 27 ventricular dysfunctions, 32 pericarditis, 15 coronaritis, 3 arrhythmias. All patients recovered, and during follow-up, no cardiac anomalies were recorded. Our experience showed that cardiac involvement is not rare in children with SARS-COV-2, and occurred in almost all patients with MIS-C. However, patients’ recovery is satisfactory and no additional events were reported during FU. Full article
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Review

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17 pages, 4152 KiB  
Review
Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C
by Bibhuti B. Das, Jyothsna Akam-Venkata, Mubeena Abdulkarim and Tarique Hussain
Children 2022, 9(7), 1061; https://doi.org/10.3390/children9071061 - 16 Jul 2022
Cited by 5 | Viewed by 3261
Abstract
Myocarditis comprises many clinical presentations ranging from asymptomatic to sudden cardiac death. The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. Echocardiography is the primary tool to detect ventricular wall motion [...] Read more.
Myocarditis comprises many clinical presentations ranging from asymptomatic to sudden cardiac death. The history, physical examination, cardiac biomarkers, inflammatory markers, and electrocardiogram are usually helpful in the initial assessment of suspected acute myocarditis. Echocardiography is the primary tool to detect ventricular wall motion abnormalities, pericardial effusion, valvular regurgitation, and impaired function. The advancement of cardiac magnetic resonance (CMR) imaging has been helpful in clinical practice for diagnosing myocarditis. A recent Scientific Statement by the American Heart Association suggested CMR as a confirmatory test to diagnose acute myocarditis in children. However, standard CMR parametric mapping parameters for diagnosing myocarditis are unavailable in pediatric patients for consistency and reliability in the interpretation. The present review highlights the unmet clinical needs for standard CMR parametric criteria for diagnosing acute and chronic myocarditis in children and differentiating dilated chronic myocarditis phenotype from idiopathic dilated cardiomyopathy. Of particular relevance to today’s practice, we also assess the potential and limitations of CMR to diagnose acute myocarditis in children exposed to severe acute respiratory syndrome coronavirus-2 infections. The latter section will discuss the multi-inflammatory syndrome in children (MIS-C) and mRNA coronavirus disease 19 vaccine-associated myocarditis. Full article
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Other

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8 pages, 252 KiB  
Brief Report
Comparison of Laboratory Data between Children with Kawasaki Disease and COVID-19
by Xiao-Ping Liu, Ying-Hsien Huang, Yuh-Chyn Tsai, Shih-Feng Liu and Ho-Chang Kuo
Children 2022, 9(5), 638; https://doi.org/10.3390/children9050638 - 28 Apr 2022
Cited by 2 | Viewed by 1677
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The [...] Read more.
Background: Coronavirus disease 2019 (COVID-19) has been an emerging, rapidly evolving situation in China since late 2019 and has even become a worldwide pandemic. The first case of severe childhood novel coronavirus pneumonia in China was reported in March 2020 in Wuhan. The severity differs between adults and children, with lower death rates and decreased severity for individuals under the age of 20 years. Increased cases of Kawasaki disease (KD) have been reported from New York City and some areas of Italy and the U.K., with almost a 6–10 times increase when compared to previous years. We conducted this study to compare characteristics and laboratory data between KD and COVID-19 in children. Methods: We obtained a total of 24 children with COVID-19 from a literature review and 268 KD cases from our hospital via retrospective chart review. Results: We found that patients with KD have higher levels of white blood cells (WBCs), platelets, neutrophil percentage, C-reactive protein (CRP), procalcitonin, and aspartate aminotransferase (AST) and a higher body temperature, while patients with COVID-19 have a higher age, hemoglobin levels, and lymphocyte percentage. After performing multiple logistic regression analysis, we found that age, WBCs, platelets, procalcitonin, and AST are identical markers for distinguishing COVID-19 from KD in children. Conclusion: In this COVID-19 pandemic period, clinicians should pay attention to children with COVID-19 infection when high WBC, platelet, procalcitonin, and AST values are present in order to provide early diagnosis for KD or multisystem inflammatory syndrome in children (MIS-C). Full article
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