Department of Pediatric Cardiology, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey.
Department of Pediatrics, University of Health Sciences, Umraniye Training and Research Hospital, İstanbul, Turkey.
Cardiol Young. 2023 Jul;33(7):1117-1123. doi: 10.1017/S1047951122002220. Epub 2022 Jul 15.
This study aimed to evaluate electrocardiographic and echocardiographic findings, Holter recordings of the multisystem inflammatory syndrome in children, and to identify prognostic factors for cardiac involvement.
We retrospectively reviewed demographic characteristics, medical data, laboratory findings, electrocardiogram and echocardiographic findings, 24-hour Holter recordings, need for an ICU, and extracorporeal membrane oxygenation in multisystem inflammatory syndrome in children. Acute left ventricular systolic dysfunction was defined as left ventricular ejection fraction (EF) ≤%55 on echocardiography.
Sixty-seven children were included in the study. 24-hour Holters were recorded in 61.2% of the patients and 49.2% were normal. On echocardiographic examination, 14.9% of the patients had systolic dysfunction (EF ≤ 55%). While 32.8% of patients had mild mitral regurgitation, 3% had moderate mitral regurgitation, and 6% had mild aortic regurgitation. There was no statistically significant difference in EF values between the group with arrhythmia in Holter and the group with normal Holter results (p ≥ 0.05). B-type natriuretic peptide was positively correlated with C-reactive protein, ferritin, and fibrinogen. Significant effectivity of the B-type natriuretic peptide value was observed in the differentiation of those with EF ≤ and > 55%. Extracorporeal membrane oxygenation support was needed for three (4.5%) patients. One patient who died had systemic juvenile idiopathic arthritis.
Neutrophil/lymphocyte ratio, C-reactive protein, D-dimer, ferritin, troponin, and B-type natriuretic peptide were found to be significantly higher in patients with systolic dysfunction. Also, the cut-off value of 1700 pg/ml for B-type natriuretic peptide was significantly effective. These parameters may indicate the severity of the disease but should be supported by prospective studies.
本研究旨在评估儿童多系统炎症综合征的心电图和超声心动图表现，以及动态心电图监测结果，并确定心脏受累的预后因素。
我们回顾性分析了儿童多系统炎症综合征患者的人口统计学特征、临床资料、实验室检查结果、心电图和超声心动图表现、24 小时动态心电图监测结果、入住重症监护病房（ICU）的需求和体外膜肺氧合（ECMO）的使用情况。急性左心室收缩功能障碍定义为超声心动图左心室射血分数（EF）≤55%。
本研究共纳入 67 例患儿。61.2%的患者进行了 24 小时动态心电图监测，其中 49.2%的监测结果正常。超声心动图检查发现，14.9%的患者存在收缩功能障碍（EF≤55%）。32.8%的患者存在轻度二尖瓣反流，3%的患者存在中度二尖瓣反流，6%的患者存在轻度主动脉瓣反流。Holter 检查有或无心律失常的患者 EF 值无统计学差异（p≥0.05）。B 型利钠肽与 C 反应蛋白、铁蛋白和纤维蛋白原呈正相关。B 型利钠肽值对 EF≤55%和 EF>55%的患者有显著的鉴别效果。3 例（4.5%）患者需要体外膜肺氧合支持。1 例死亡患者患有全身型幼年特发性关节炎。
与收缩功能正常的患者相比，收缩功能障碍患者的中性粒细胞/淋巴细胞比值、C 反应蛋白、D-二聚体、铁蛋白、肌钙蛋白和 B 型利钠肽显著升高。B 型利钠肽的截断值为 1700 pg/ml 时具有显著的鉴别效果。这些参数可能提示疾病的严重程度，但需要前瞻性研究加以证实。
