Abstract
Cardiac involvement associated with multi-system inflammatory syndrome in children has been extensively reported, but the prevalence of cardiac involvement in children with SARS-CoV-2 infection in the absence of inflammatory syndrome has not been well described. In this retrospective, single centre, cohort study, we describe the cardiac involvement found in this population and report on outcomes of patients with and without elevated cardiac biomarkers. Those with multi-system inflammatory syndrome in children, cardiomyopathy, or complex CHD were excluded. Inclusion criteriaz were met by 80 patients during the initial peak of the pandemic at our institution. High-sensitivity troponin T and/or N-terminal pro-brain type natriuretic peptide were measured in 27/80 (34%) patients and abnormalities were present in 5/27 (19%), all of whom had underlying comorbidities. Advanced respiratory support was required in all patients with elevated cardiac biomarkers. Electrocardiographic abnormalities were identified in 14/38 (37%) studies. Echocardiograms were performed on 7/80 patients, and none demonstrated left ventricular dysfunction. Larger studies to determine the true extent of cardiac involvement in children with COVID-19 would be useful to guide recommendations for standard workup and management.
Highlights
Cardiac involvement in patients with COVID-19 has been extensively described in the adult literature with evidence suggesting that elevations in cardiac biomarkers such as high-sensitivity troponin T and N-terminal pro-brain type natriuretic peptide are associated with more severe disease including mechanical ventilation and inotropic support.1–7 Though cardiac findings have been well described in cases of multi-system inflammatory syndrome in children,8,9 robust data are not available for children with positive COVID-19 tests who do not have multi-system inflammatory syndrome in children
We described our approach to the cardiac evaluation of children with COVID-19 based on expert opinion
Patients with suspected multi-system inflammatory syndrome in children should undergo more complete cardiac workup based on institutional protocol
Summary
Cardiac involvement in patients with COVID-19 has been extensively described in the adult literature with evidence suggesting that elevations in cardiac biomarkers such as high-sensitivity troponin T and N-terminal pro-brain type natriuretic peptide are associated with more severe disease including mechanical ventilation and inotropic support. Though cardiac findings have been well described in cases of multi-system inflammatory syndrome in children, robust data are not available for children with positive COVID-19 tests who do not have multi-system inflammatory syndrome in children. Cardiac involvement in patients with COVID-19 has been extensively described in the adult literature with evidence suggesting that elevations in cardiac biomarkers such as high-sensitivity troponin T and N-terminal pro-brain type natriuretic peptide are associated with more severe disease including mechanical ventilation and inotropic support.. Though cardiac findings have been well described in cases of multi-system inflammatory syndrome in children, robust data are not available for children with positive COVID-19 tests who do not have multi-system inflammatory syndrome in children. We describe the cardiac findings in children with acute COVID-19 who received care at a large tertiary care children’s hospital in New York City, the initial epicentre in the United States of America, and describe outcomes in this population. We hope to use this information to standardise cardiac workup and monitoring in children with acute presentations of COVID-19 infection and guide early management decisions
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