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

European Heart Journal Cardiovascular Imaging - Tập 22 Số 8 - Trang 896-903 - 2021
Paraskevi Theocharis1, James Wong1, Kuberan Pushparajah1,2, Sujeev Mathur1, John Simpson1, Emma Pascall1, Aoife Cleary1, Kirsty Stewart1, Kaitav Adhvaryu1, Alex Savis1, Saleha Kabir1, Mirasol Pernia Uy1, Hannah Heard1, Kelly Peacock1, Owen Miller1,3
1Department of Paediatric Cardiology, Evelina London Children's Hospital, UK
2School of Biomedical Engineering and Imaging Sciences, King's College London, UK
3Department of Women and Children’s Health, Faculty of Life Science and Medicine, King’s College London, UK

Tóm tắt

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.

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European Heart Journal Cardiovascular Imaging

Tập 22 Số 8

896-903

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