Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
ESC Heart Fail. 2021 Dec;8(6):5583-5588. doi: 10.1002/ehf2.13678. Epub 2021 Oct 27.
Our study aimed to investigate the cardiac involvement with sensitive tissue characterization in non-hospitalized children with coronavirus disease 2019 (COVID-19) infection using cardiovascular magnetic resonance (CMR) imaging.
We prospectively enrolled children who recovered from mildly symptomatic COVID-19 infection between November 2020 and January 2021. Patients underwent CMR at 1.5 T (Achieva, Philips Healthcare, Best, the Netherlands) including cine images, native T1 and T2 mapping. Healthy children and paediatric patients with biopsy-proven myocarditis served as control groups. We performed CMR in 18 children with a median (25th-75th percentile) age of 12 (10-15) years, 38 (24-47) days after positive PCR test, and compared them with 7 healthy controls [15 (10-19) years] and 9 patients with myocarditis [10 (4-16) years]. The COVID-19 patients reported no cardiac symptoms. None of the COVID-19 patients showed CMR findings consistent with a myocarditis. Three patients (17%) from the COVID-19 cohort presented with minimal pericardial effusion. CMR parameters of COVID-19 patients, including volumetric and strain values as well as T1 and T2 times, were not significantly different from healthy controls, but from myocarditis patients. These had significantly reduced left ventricular (LV) ejection fraction (P = 0.035), LV global longitudinal strain, and left atrial strain values as well as elevated native T1 values compared with COVID-19 patients (P < 0.001, respectively).
There was no evidence of myocardial inflammation, fibrosis, or functional cardiac impairment in the studied cohort of children recently. CMR findings were comparable with those of healthy controls. Pericardial effusion suggests a mild pericarditis in a small subgroup. This is pointing to a minor clinical relevance of myocardial involvement in children after mildly symptomatic COVID-19 infections.
本研究旨在使用心血管磁共振（CMR）成像技术，研究非住院的 2019 年冠状病毒病（COVID-19）感染患儿的心脏受累情况及其敏感组织特征。
我们前瞻性地招募了 2020 年 11 月至 2021 年 1 月期间从轻度症状 COVID-19 感染中康复的儿童患者。患者在 1.5T（Achieva，飞利浦医疗保健，Best，荷兰）上接受 CMR 检查，包括电影图像、原生 T1 和 T2 映射。健康儿童和经活检证实的心肌炎患儿作为对照组。我们对 18 名年龄中位数（25 至 75 百分位数）为 12 岁（10 至 15 岁）的 COVID-19 患儿进行了 CMR 检查，他们在阳性 PCR 检测后 38 天（24 至 47 天）进行了检查，并与 7 名健康对照组（15 岁（10 至 19 岁）岁）和 9 名心肌炎患者（10 岁（4 至 16 岁）岁）进行了比较。COVID-19 患儿无心脏症状。COVID-19 患者均无 CMR 检查结果符合心肌炎的表现。COVID-19 组中有 3 名患者（17%）存在轻微的心包积液。COVID-19 患者的 CMR 参数，包括容积和应变值以及 T1 和 T2 时间，与健康对照组无显著差异，但与心肌炎患者有显著差异。与 COVID-19 患者相比，这些患者的左心室（LV）射血分数（P=0.035）、LV 整体纵向应变和左心房应变值以及原生 T1 值均显著降低（P<0.001）。
在本研究的患儿队列中，最近没有发现心肌炎症、纤维化或功能心脏损伤的证据。CMR 结果与健康对照组相似。心包积液表明一小部分患者存在轻度心包炎。这表明在轻度症状 COVID-19 感染后，儿童心肌受累的临床相关性较小。
