Analysis of cardiac manifestation and treatment of multisystem inflammatory syndrome in children related to SARS-CoV-2

Stasa Krasic; Sanja Ninic; Sergej Prijic; Sasa Popovic; Srdjan  Pasic; Gordana Petrovic; Boris Zec; Snezana Ristic; Dejan Nesic; Luka Nikolic; Vladislav Vukomanovic

doi:10.17305/bjbms.2022.7820

Authors

Stasa Krasic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Sanja Ninic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Sergej Prijic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Sasa Popovic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Srdjan Pasic Immunology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Gordana Petrovic Immunology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Boris Zec Pediatric Clinic, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
Snezana Ristic Intensive care unit, Mother and Child Health Institute of Serbia, Belgrade, Serbia
Dejan Nesic Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Luka Nikolic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia
Vladislav Vukomanovic Cardiology Department, Faculty of Medicine, Mother and Child Health Institute of Serbia, University of Belgrade, Belgrade, Serbia https://orcid.org/0000-0002-5244-1436

DOI:

https://doi.org/10.17305/bjbms.2022.7820

Keywords:

Acute myocardial dysfunction, shock, pediatric, SARS-CoV-2, MIS-C

Abstract

Cardiovascular manifestations are common (35–100%) in the multisystem inflammatory syndrome in children. Our study aimed to analyze treatment impact and cardiovascular involvement in patients with multisystem inflammatory syndrome in children. The retrospective cohort included 81 patients treated between April 2020 and December 2021 (9.3±4.6 years). Elevated cardiac troponin I and pro-B-type natriuretic peptide were observed in 34.2% and 88.5% of patients, respectively. Myocardial dysfunction was observed in 50.6%. Children older than 10 years had a 4-fold increased risk of myocardial dysfunction (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.4-8.9; p=0.006). A moderate negative correlation was proved between left ventricle ejection fraction and C-reactive protein (rr = - 0.48; p < 0.001). More than one-fifth of the patients presented with shock. Coronary artery dilatation was observed in 6.2% of patients. Mild pericardial effusion was detected in 27.1% of children. On standard electrocardiogram, 52.6% of children had negative T waves in the inferior and/or precordial leads; transient QTc prolongation was registered in 43% of patients. Treatment failure was observed in 19 patients. Patients initially treated with intravenous immunoglobulins had 10-fold higher chances for treatment failure than patients treated with corticosteroids (OR 10.6, 95% CI 3,18 – 35.35; p < 0.001). Cardiovascular manifestations were observed in more than half of the patients, with acute myocardial dysfunction being the most common, especially in children older than 10 years. We established a negative association between the degree of elevation of inflammatory markers and left ventricular ejection fraction. Patients treated with intravenous immunoglobulins who had cardiovascular manifestations had treatment failures more frequently than patients treated with corticosteroids.