Letter by Navarro Castellanos and Dahdah Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic”

Abstract

HomeCirculationVol. 143, No. 10Letter by Navarro Castellanos and Dahdah Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Navarro Castellanos and Dahdah Regarding Article, “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic” Iñaki Navarro Castellanos and Nagib Dahdah Iñaki Navarro CastellanosIñaki Navarro Castellanos https://orcid.org/0000-0002-7680-0835 Pediatric Cardiology Department, CHU-Saint Justine, Université de Montréal, Quebec, Canada. Search for more papers by this author and Nagib DahdahNagib Dahdah Pediatric Cardiology Department, CHU-Saint Justine, Université de Montréal, Quebec, Canada. Search for more papers by this author Originally published8 Mar 2021https://doi.org/10.1161/CIRCULATIONAHA.120.049239Circulation. 2021;143:e759–e760To the Editor:We read with interest the article “Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic” by Belhadjer et al1 and are grateful for the effort to rapidly advance the knowledge of clinical presentations associated with the novel coronavirus. In light of our reading and interpretation of the content of the article, we request that the authors clarify some points.What causes Kawasaki disease (KD) is still not known, but there is evidence that a transitory autoimmune response after an external exposure to infectious agents, such as viral respiratory infections.2 The entity known as KD shock syndrome, described initially in a series by Dominguez et al3 in 2008 and later with suggested case definition by Kanegaye et al4 in 2009, has many similarities with the multisystem inflammatory syndrome in children such as hemodynamic instability, impaired left ventricle (LV) function, and what seems a greater incidence of coronary artery abnormalities, higher C-reactive protein concentrations, and intravenous immunoglobulin resistance. From this perspective, it would have been helpful to the reader and for the future utility of the paper (for meta-analysis statistics, for instance) if the clinical criteria of KD were made available in a table and the possible associative statistics for patient outcomes.In the Discussion of the original article, the authors argue that one main difference between patients with KD shock syndrome and patients with multisystem inflammatory syndrome in children is that the LV dysfunction was present in all patients with multisystem inflammatory syndrome in children compared with only one-third of the patients with KD shock syndrome. Because LV dysfunction was an inclusion criterion for multisystem inflammatory syndrome in children, the difference is simply spurious. Other minor clinical or laboratory differences in the article could be the result of the small sample size, an aspect we believe should be mentioned.From another perspective, there is inconsistency in the definition of normal LV ejection fraction because the initial classification is defined by an LV ejection fraction <50%, and in Table 2, the normal cutoff is 60%. In addition, the results in Table 2 show recovery of the LV ejection fraction at day 7, whereas results shown in the text mention LV ejection fraction recovery in 2 days. Also, we would like the authors to clarify whether other parameters such as strain, E/a ratio, or E/e’ ratio were used for this myocardial dysfunction classification. Along the same lines, we found it surprising how many patients were placed under extracorporeal mechanical support/mechanical assistance, and request the authors to clarify. More precisely, what criteria were used that led to that support?Overall, the authors brought valuable information. We sincerely hope they can address our points for better clarity among the many uncertainties during this pandemic.Disclosures None.Footnoteshttps://www.ahajournals.org/journal/circ