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

Vladislav Vukomanovic; Stasa Krasic; Sergej Prijic; Gordana Petrovic; Sanja Ninic; Sasa Popovic; Ivana Cerovic; Snezana Ristic; Dejan Nesic

doi:10.4103/jrms.JRMS_1195_20

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

J Res Med Sci. 2021 Nov 29:26:113. doi: 10.4103/jrms.JRMS_1195_20. eCollection 2021.

Authors

Vladislav Vukomanovic^{1

2}, Stasa Krasic¹, Sergej Prijic^{1

2}, Gordana Petrovic³, Sanja Ninic¹, Sasa Popovic¹, Ivana Cerovic¹, Snezana Ristic⁴, Dejan Nesic⁵

Affiliations

¹ Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia.
² School of Medicine, University of Belgrade, Belgrade, Serbia.
³ Department of Immunology, Mother and Child Health Institute of Serbia, Belgrade, Serbia.
⁴ Intensive Care Unit, Mother and Child Health Institute of Serbia, Belgrade, Serbia.
⁵ Institute of Medical Physiology "Rihard Burian", Belgrade, Serbia.

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.