Borka Balas Reka, Meliț Lorena Elena, Mărginean Cristina Oana
Department of Pediatrics I, "George Emil Palade'' University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania.
Rev Cardiovasc Med. 2023 Apr 24;24(5):125. doi: 10.31083/j.rcm2405125. eCollection 2023 May.
Although initially the evolution of Coronavirus disease 2019 (COVID-19) seemed less severe in pediatric patients, in the three years since the beginning of the pandemics, several severe cases have been described, pediatric inflammatory multisystem syndrome (PIMS) has been defined, pathogenesis is being continuously studied, and many aspects regarding the long-term evolution and multi-organ damage are still unexplained. Cardiac injuries in COVID-19 represent most-likely the second cause of mortality associated with the infection. A wide-spectrum of cardiac abnormalities were reported to be associated with COVID-19 in children including ventricular dysfunction, acute myocardial dysfunction, arrhythmias, conduction abnormalities, coronary artery dilation or aneurysms, and less common pericarditis and valvulitis. Risk factors for severe COVID-19 in children should be identified, laboratory tests and imaging techniques should be performed to reveal cardiac injury as soon as possible. The aim of this review was to highlight the great value of repeated cardiological monitoring in patients with COVID-19, underlining also the peculiarities in terms of pediatric population. This review is looking for answers on questions like 'Why do some, but not all, patients with COVID-19 develop cardiac injury or severe hyperinflammatory status?', 'Which factors are involved in triggering COVID-19 associated cardiac injury?', 'What are the mechanisms involved in the etiology of cardiac injury?', 'Is there a clear relationship between hyperinflammation and cardiac injury?', 'Is hyperinflammatory status the pre-stage of cardiac injury in COVID-19 patients?' which still lack clear answers. The understanding of mechanisms involved in the development of COVID-19 associated cardiac injury might shed light on all the above-mentioned mysteries and might increase the likelihood of favorable evolution even in severe cases.
尽管最初2019冠状病毒病（COVID-19）在儿科患者中的演变似乎不那么严重，但自大流行开始后的三年里，已描述了几例严重病例，小儿炎症性多系统综合征（PIMS）已被定义，发病机制正在不断研究，而且关于长期演变和多器官损伤的许多方面仍无法解释。COVID-19中的心脏损伤很可能是与该感染相关的第二大死亡原因。据报道，儿童COVID-19与一系列广泛的心脏异常有关，包括心室功能障碍、急性心肌功能障碍、心律失常、传导异常、冠状动脉扩张或动脉瘤，以及较罕见的心包炎和瓣膜炎。应确定儿童严重COVID-19的危险因素，应进行实验室检查和成像技术以尽快发现心脏损伤。本综述的目的是强调对COVID-19患者进行重复心脏监测的巨大价值，同时也强调儿科人群的特殊性。本综述旨在寻找以下问题的答案，如“为什么有些但不是所有COVID-19患者会出现心脏损伤或严重的高炎症状态？”、“哪些因素参与引发COVID-19相关的心脏损伤？”、“心脏损伤病因中的机制是什么？”、“高炎症与心脏损伤之间是否存在明确的关系？”、“高炎症状态是否是COVID-19患者心脏损伤的前期阶段？”，这些问题仍然缺乏明确的答案。对COVID-19相关心脏损伤发生机制的理解可能会揭示上述所有谜团，并可能增加即使在严重病例中也有良好转归的可能性。
