ABSTRACT
Background and Aim: The objective of the study was to assess the features of acute myocarditis and compare Covid19 and non-Covid19 cases. Method(s): Patients lt;18y with acute myocarditis (proved by virology and/or MRI and/or complete recovery of myocardial function) were included. Clinical data, echocardiographic parameters and outcomes were collected. Cases were divided in groups I (non-Covid), II (Covid). Result(s): From 1983 to 2021, 139 patients were included: 76 patients in group I and 63 in group II, 67males (31 in group I = 40% vs 36 in II = 57%). Mean age at diagnosis was 6.8 years: 4.2 years in group I vs 9.9 years in II. Heart failure (HF) was present at onset in 78% of cases in group I and 50% in group II: severe HF was more frequent in group I, chest pain was more frequent in II. Mean left ventricular shortening fraction (LVSF) at diagnosis was 23.8%: 18.4% in groups I vs 31.6% in II (plt;0.05). Mitral regurgi-tation was present in 63.8% of cases = 76.5% vs 43.8% respectively in groups I and II, pericarditis in 16.4% (no difference between groups), thromboembolic events occurred in 7% and arrhythmias in 10% ((all in group I). Virus was positive in 37.5% in group I and SARS-Cov2 positive in all of group II. Inotrope support was needed in 47%, mechanical circulatory support in 8% in group I only. Eleven patients died in group I, no death occurred in group II. One was transplanted(3rdmonth) and 19 have sequellae in group I. Complete recovery occurred in 74% of all cases: 40 of group I (58%) and all of group II (100%): time to recovery was longer in group I (2 years) than in group I (2 weeks). Mean LVSF improved from 18.4% at onset, to 24.6% at 1st month, 26.5% at 3rd month, 30.7% at 6th month and 38% at last FU in group I, while mean LVSF normalized within 2 weeks after onset in group II. Conclusion(s): Myocardial dysfunction and heart failure were less fre-quent, and complete recovery occurred promptly in COVID cases, while myocardial improvement progressed slowly within first 6months and beyond in half of non-COVID cases.
ABSTRACT
Background: Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention. Methods: Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state. Results: Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2-16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third;80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned. Conclusions: Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.