Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T01:06:36.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiac outcomes in severe acute respiratory syndrome coronavirus-2-associated multisystem inflammatory syndrome at a tertiary paediatric hospital

Part of: Infectious

Published online by Cambridge University Press:  10 December 2021

Filip Kucera ,
Craig Laurence Open the ORCID record for Craig Laurence [Opens in a new window] ,
Jacob Simmonds ,
Javier Gavela ,
Tetyana Bodnar ,
Paul Brogan ,
Aparna Hoskote ,
Sophie Skellett ,
Karyn Moshal  and
Alasdair Bamford
...Show all authors
Filip Kucera*
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Craig Laurence
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Jacob Simmonds
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Javier Gavela
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Tetyana Bodnar
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Paul Brogan
Affiliation:
Department of Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK Institute of Child Health, University College London, London, UK
Aparna Hoskote
Affiliation:
Cardiac Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Sophie Skellett
Affiliation:
Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Karyn Moshal
Affiliation:
Infectious Diseases Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Alasdair Bamford
Affiliation:
Infectious Diseases Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Sachin Khambadkone
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
*
Author for correspondence: Dr F. Kucera, MD, Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, LondonWC1N 3JH, UK. Tel: 020 7405 9200. E-mail: Filip.Kucera@gosh.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

We describe a cohort of children referred with multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 and compare this cohort with a 2019 cohort of children with Kawasaki disease.

Methods:

We conducted a retrospective cohort study of 2019 and 2020 referrals to the inflammatory cardiology service at Great Ormond Street Hospital for Children. We compared cardiac and inflammatory parameters of a sub-section of the 2020 cohort who presented with reduced left ventricular ejection fraction with the remainder of the cohort.

Results:

Referrals significantly increased between February and June 2020 compared to 2019 (19.8/30 days versus 3.9/30 days). Frequency of coronary artery aneurysms (11/79 (13.9%) versus 7/47 (14.9%)) or severe coronary artery aneurysms (6/79 (7.6%) versus 3/47 (6.4%)) was similar between 2020 and 2019, respectively. The 2020 cohort was older (median age 9.07 years versus 2.38 years), more likely to be of Black, Asian, or other minority ethnic group (60/76 (78.9%) versus 25/42 (59.5%)), and more likely to require inotropic support (22 (27.5%) versus 0 (0%)). Even children with significantly reduced left ventricular ejection fraction demonstrated complete recovery of cardiac function within 10 days (mean 5.25 days ± 2.7).

Discussion:

We observed complete recovery of myocardial dysfunction and an overall low rate of permanent coronary sequelae, indicating that the majority of children with multisystem inflammatory syndrome in children are unlikely to encounter long-term cardiac morbidity. Although the frequency of myocardial dysfunction and inotropic support requirement is not consistent with a diagnosis of Kawasaki disease, the frequency of coronary artery abnormalities and severe coronary artery abnormalities suggests a degree of phenotypic overlap.

Keywords

COVID-19Kawasaki diseaseinflammatorymyocarditiscoronary artery aneurysm
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1585 - 1591
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

References

Wang, D, Hu, B, Hu, C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. China JAMA 2020; 323: 1061–1069.CrossRefGoogle ScholarPubMed
Dong, Y, Mo, X, Hu, Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145: e20200702.CrossRefGoogle ScholarPubMed
Whittaker, E, Bamford, A, Kenny, J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020; 324: 259–269.CrossRefGoogle ScholarPubMed
Alsaied, T, Tremoulet, A, Burns, JC, et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation 2021; 143: 78–88.CrossRefGoogle ScholarPubMed
Riphagen, S, Gomez, X, Gonzalez-Martinez, C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607–1608.CrossRefGoogle ScholarPubMed
Verdoni, L, Mazza, A, Gervasoni, A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 6736: 1–8.Google Scholar
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429–436.CrossRefGoogle ScholarPubMed
Royal College of Paediatrics and Child Health [Internet]. London: Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19, 2020. Retrieved January 4 2021, from https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf Google Scholar
Centres for Disease Control and Prevention [Internet]. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Washington, DC, 2020. Retrieved Jaunary 4 2021, from https://emergency.cdc.gov/han/2020/han00432.asp Google Scholar
Freedman S, Godfred-Cato S, Gorman, R, et al, World Health Organization [internet]. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief, 2020. Retrieved January 4 2021, from https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19 Google Scholar
Julie Toubiana, J, Poirault, C, Corsia, A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094. doi: 10.1136/bmj.m2094.Google Scholar
Shekerdemian, LS, Mahmood, NR, Wolfe, KW, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr 2020; 2019: E1–E6.Google Scholar
Shulman, ST. Pediatric coronavirus disease-2019-associated multisystem inflammatory syndrome. J. Pediatric Infect Dis Soc 2020; 9: 285–286.CrossRefGoogle ScholarPubMed
Consiglio, CR, Cotugno, N, Sardh, F, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell 2020; 183: 968–981.CrossRefGoogle ScholarPubMed
Capone, CA, Subramony, A, Sweberg, T, et al. Characteristics, cardiac involvement, and outcomes of multisystem inflammatory disease of childhood (MIS-C) associated with SARS-CoV-2 infection. J. Pediatr 2020; 224: 141–145.CrossRefGoogle Scholar
Davies, P, Evans, C, Kanthimathinathan, HK, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Heal 2020; 4: 669–677.CrossRefGoogle ScholarPubMed
Ramcharan, T, Nolan, O, Lai, CY, et al. 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; 41: 1391–1401.CrossRefGoogle Scholar
McCrindle, BW, Li, JS, Minich, LL, et al. Coronary artery involvement in children with Kawasaki disease. Circulation 2007; 116: 174–179.CrossRefGoogle ScholarPubMed
McCrindle, BW, Rowley, AH, Newburger, JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: e927–e999.CrossRefGoogle ScholarPubMed
Burns, JC, Herzog, L, Fabri, O, et al. Seasonality of Kawasaki disease: a global perspective. PLoS One 2013; 8: e74529.CrossRefGoogle ScholarPubMed
de Graeff, N, Groot, N, Ozen, S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease – the SHARE initiative. Rheumatology 2019; 58: 672–682.CrossRefGoogle ScholarPubMed
Canter, CE, Simpson, KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation 2014; 129: 115–128.CrossRefGoogle ScholarPubMed
Ahmed, M, Advani, S, Moreira, A, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine 2020; 26: 100527.CrossRefGoogle ScholarPubMed
Laurence, C, Haini, M, Thiruchelvam, T, et al. Endomyocardial biopsy in a pediatric patient with cardiac manifestations of COVID-19. Circ Heart Fail 2020; 13: 690–692.CrossRefGoogle Scholar
Peretto, G, Sala, S, Caforio, ALP. Acute myocardial injury, MINOCA, or myocarditis? Improving characterization of coronavirus-associated myocardial involvement. Eur Heart J 2020; 41: 2124–2125.CrossRefGoogle ScholarPubMed
Patnaik, S, Jain, MK, Ahmed, S, et al. Short-term outcomes in children recovered from multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Rheumatol Int 2021; 41: 1957–1962. DOI 10.1007/s00296-021-04932-1.CrossRefGoogle ScholarPubMed
Yu, JJ, Jang, W-S, Ko, HK, et al. Perivascular brightness of coronary arteries in Kawasaki disease. J Pediatr 2011; 159: 454–457.CrossRefGoogle ScholarPubMed
Binstadt, BA, Levine, JC, Nigrovic, PA. Coronary artery dilation among patients presenting with systemic-onset juvenile idiopathic arthritis. Pediatrics 2005; 116: e89–e93.CrossRefGoogle ScholarPubMed
Nicholson, GT, Hsu, DT, Colan, SD, et al. Coronary artery dilation in sickle cell disease. J Pediatr 2011; 159: 789–794.CrossRefGoogle ScholarPubMed