Cardiopulmonary exercise test in children with pediatric inflammatory multisistemic syndrome associated with COVID-19 (PIMS)

ABSTRACT

Background and Aim: Coronavirus infection (COVID-19) in paedi-atric population has a generally mild course. In Spain, patients under 15 years old have accounted only for 0,4% of hospital admis-sions and 0,7% of intensive care admissions. However, in May 2020, cases of children with a systemic inflammatory syndrome related to a recent COVID-19 infection were described. In severe forms, left ventricular systolic dysfunction, mitral regurgitation, pericardial effusion and coronary artery dilatation or aneurysms have been described. The aim of this study is to describe the results obtained in cardiopulmonary exercise test (CPET) in previously healthy patients with PIMS. Method(s) Prospective study of PIMS patients who performed CPET. Godfrey ramp protocol recommended by European Society of Cardiology (ESC) was used in all cases. Measured var-iables, expressed by predicted values, were forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of minute venti-lation to carbon dioxide production (VE/VO2 slope), maximal oxygen consumption (VO2 max), oxygen uptake efficiency slope (OUES), oxygen pulse (O2 pulse) and maximum heart rate (HR). Result(s) Eight patients (75% boys) aged 5-14 years (median 10,5 years) performed CPET reaching a mean peak load of 105,87 W (median 112,5 W and mean load per kg of weight 2,34 W/kg). Only 1 patient (12,5%) presented basal spirometric disturb-ances in context of asthma without chronic treatment. Obtained mean respiratory parameters were FVC 97,88%, FEV1 92,7%, Tiffeneau 83% and VECO2p 32,47. Oxygen satu-ration before and after CPET was greater than 95% in 100% of patients. In 6 patients (75%) the V02max and oxygen pulse was greater than 80% of predicted value (100% of patients reached at least 40% of V02 max at anaerobic threshold). Obtained mean cardiovascular parameters were VO2 max 1624mL/min (median 1655 ml/min and V02 per kg of weight 36,9 ml/kg), pulse oxygen 9 ml and OUES 1,92. Conclusion(s) PIMS may cause severe cardiac disturbances justifying cardiological monitoring of these patients. CPET allows to assess functional capacity of these children after the disease. In our serie, most of patients had a good functional capacity (75%). Studies with more patients are needed to make extended conclusions.