Ludwikowska Kamila M, Moksud Nafeesa, Tracewski Paweł, Sokolski Mateusz, Szenborn Leszek
Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland.
Laboratory of Genetics and Epigenetics of Human Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Rudolfa Weigla 12, 53-114 Wrocław, Poland.
Biomedicines. 2023 Apr 23;11(5):1251. doi: 10.3390/biomedicines11051251.
Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cardiovascular system is commonly involved. Acute heart failure (AHF) is the most severe complication of MIS-C, leading to cardiogenic shock. The aim of the study was to characterise the course of MIS-C with a focus on cardiovascular involvement, based on echocardiographic (echo) evaluation, in 498 children (median age 8.3 years, 63% boys) hospitalised in 50 cities in Poland. Among them, 456 (91.5%) had cardiovascular system involvement: 190 (48.2%) of patients had (most commonly atrioventricular) valvular insufficiency, 155 (41.0%) had contractility abnormalities and 132 (35.6%) had decreased left ventricular ejection fraction (LVEF < 55%). Most of these abnormalities improved within a few days. Analysis of the results obtained from two echo descriptions (a median of 5 days apart) revealed a >10% increase in LVEF even in children with primarily normal LVEF. Lower levels of lymphocytes, platelets and sodium and higher levels of inflammatory markers on admission were significantly more common among older children with contractility dysfunction, while younger children developed coronary artery abnormality (CAA) more often. The incidence of ventricular dysfunction might be underestimated. The majority of children with AHF improved significantly within a few days. CAAs were relatively rare. Children with impaired contractility as well as other cardiac abnormalities differed significantly from children without such conditions. Due to the exploratory nature of this study, these findings should be confirmed in further studies.
儿童多系统炎症综合征（MIS-C）是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的一种免疫介导并发症。心血管系统常受累。急性心力衰竭（AHF）是MIS-C最严重的并发症，可导致心源性休克。本研究旨在基于超声心动图（echo）评估，对波兰50个城市住院的498名儿童（中位年龄8.3岁，63%为男孩）中以心血管受累为重点的MIS-C病程进行特征描述。其中，456名（91.5%）有心血管系统受累：190名（48.2%）患者有（最常见的是房室）瓣膜功能不全，155名（41.0%）有收缩功能异常，132名（35.6%）左心室射血分数降低（LVEF<55%）。这些异常大多在数天内改善。对两次超声心动图描述（相隔中位时间5天）所得结果的分析显示，即使是初始LVEF正常的儿童，其LVEF也增加了>10%。入院时淋巴细胞、血小板和钠水平较低以及炎症标志物水平较高在有收缩功能障碍的大龄儿童中更为常见，而小龄儿童更常发生冠状动脉异常（CAA）。心室功能障碍的发生率可能被低估。大多数AHF儿童在数天内有显著改善。CAA相对少见。有收缩功能受损以及其他心脏异常的儿童与无此类情况的儿童有显著差异。由于本研究的探索性性质，这些发现应在进一步研究中得到证实。
