ACUTE PEDIATRIC MYOCARDITIS BEFORE AND DURING SARS-CoV-2 PANDEMIC

ABSTRACT

Introduction: Acute myocarditis (AM) is an inflammatory disease of the myocardium. Myocardial injury in COVID-19 could appear as a result of the directvirus attacking, or viral-inducedmyocardial inflammationas a consequence of the aggressiveimmuneresponse.The aim of our study is a comparative analysis of the difference between children with AM before and during the SARS-CoV-2 pandemic. Methods: The retrospective analysis included all patients treated in our Institute with a diagnosisofAMfromJanuary2018toNovember 2020. Results: 24 patients were included in the study;in all patients (7/24) treated from April to November 2020, the infection was caused by SARS-CoV-2 (2 PCR, 5 serological tests of IgM antibodies). All patients with AM during the pandemic were older than 7 years. They were more likely to have abdominal pain (p=0.014), headache (p=0.003), cutaneous rash (p=0.003), conjunctivitis (p=0.003), while fulminant myocarditis was more commonly registered before the pandemic (p=0.04). A multisystem inflammatory syndrome in children associated with COVID-19 was present in 6 patients. Patients with AM in the pandemic had significantly lower values of troponin I (cTnI) (p=0.012), and platelets (p<0.001), but higher values of serum creatinine (p=0.013) and CRP (p=0.04) compared with patients before the pandemic. In the group of patients during the pandemic, a significant CRP reduction (p=0.007) was observed on the day of discharge compared to admission value. In the group of patients before the pandemic, cTnI values were significantly reduced (p=0.002). A significant recovery of systolic function was registered on the third in-hospital day in the group of patients presented during the pandemic (EF p=0.001;FS p=0.019);improvement was not observed in the group before COVID-19 pandemic. Adverse events were observed frequently in patients before the pandemic (p=0.04;3 died, and 4 dilated cardiomyopathy). Conclusions: In contrast to patients before the pandemic, in patients with AM during the COVID-19 pandemic, significantly higher values of inflammatory parameters, polymorphic clinical presentation as well as prompt recovery of LV function after applied therapy noticed in patients during SARS-CoV-2 pandemic underlie a possible new spectrum inflammatory disease with consequence viral-related myocardial inflammation with favorable prognosis.