Heart Involvement in Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children: The Retrospective Multicenter Cohort Data

Mikhail M Kostik; Liudmila V Bregel; Ilia S Avrusin; Olesya S Efremova; Konstantin E Belozerov; Elena A Dondurei; Tatiana L Kornishina; Eugenia A Isupova; Natalia N Abramova; Eugeniy Yu Felker; Vera V Masalova; Andrey V Santimov; Yuri A Kozlov; Alexander O Barakin; Ludmila S Snegireva; Julia Konstantinova; Alla A Vilnits; Maria K Bekhtereva; Vera M Argunova; Alla E Matyunova; Polina A Sleptsova; Tatyana E Burtseva; Vladimir V Shprakh; Tatyana V Boyko; Olga V Kalashnikova; Vyacheslav G Chasnyk

doi:10.3389/fped.2022.829420

Heart Involvement in Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children: The Retrospective Multicenter Cohort Data

Front Pediatr. 2022 Mar 2:10:829420. doi: 10.3389/fped.2022.829420. eCollection 2022.

Authors

Mikhail M Kostik¹, Liudmila V Bregel^{2

3}, Ilia S Avrusin¹, Olesya S Efremova³, Konstantin E Belozerov¹, Elena A Dondurei^{4

5}, Tatiana L Kornishina¹, Eugenia A Isupova¹, Natalia N Abramova¹, Eugeniy Yu Felker¹, Vera V Masalova¹, Andrey V Santimov¹, Yuri A Kozlov³, Alexander O Barakin^{2

3}, Ludmila S Snegireva¹, Julia Konstantinova⁶, Alla A Vilnits^{1

6}, Maria K Bekhtereva^{1

6}, Vera M Argunova⁷, Alla E Matyunova³, Polina A Sleptsova⁷, Tatyana E Burtseva^{8

9}, Vladimir V Shprakh², Tatyana V Boyko², Olga V Kalashnikova¹, Vyacheslav G Chasnyk¹

Affiliations

¹ Hospital Pediatry Department, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.
² Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, Irkutsk, Russia.
³ Irkutsk Regional Children's Hospital, Irkutsk, Russia.
⁴ Scientific Research Institute of Influenza n.a. A.A. Smorodintsev, Saint Petersburg, Russia.
⁵ Children's City Clinical Hospital # 5 n.a. N.F. Filatov, Saint Petersburg, Russia.
⁶ Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg, Russia.
⁷ Republic Hospital #1-National Center of Medicine, Yakutsk, Russia.
⁸ Department of Pediatrics and Pediatric Surgery, North-Eastern Federal University (NEFU), Yakutsk, Russia.
⁹ Yakut Research Center of Complex Medical Problems, Yakutsk, Russia.

Abstract

Objectives: Heart involvement in multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a new challenging problem, requiring fast and reliable diagnostics and appropriate treatment. The aim of this study is to describe heart involvement in patients with MIS-C.

Study design: In this retrospective, multicenter cohort study, data of 122 patients were included. All patients met WHO and CDC criteria of MIS-C.

Results: Various types of heart involvement in MIS-C patients were observed. Patients with solely coronary artery lesions (CAL, n = 10, 8.2%) had typical features of Kawasaki disease: younger age, thrombocytosis and normal ferritin level, without giant CA aneurysms, thrombosis, myocardial infarction, shock, and ICU admission. Patients with solely myocardial involvement (MI, n = 30, 24.6%) had an older onset age, elevated ferritin, LDH, the highest D-dimer, H score, and thrombocytopenia level. The following clinical signs were associated with MI: gastrointestinal and central nervous system disorder, sore throat, swelling face, splenomegaly, shock, and treatment in the intensive care unit required. Patients with a combination of CAL and MI (n = 10, 8.2%) had symptoms similar to patients with solely MI, except for impressive thrombocytopenia. Shock and ICU admission were found in 34.7% of patients without heart involvement (n = 72, 59%). One major criterion [troponin > 32 pg/ml (52 points)] or at least two minor criteria [face swelling (32 points) and D-Dimer > 1,300 ng/ml (29 points)] were associated with MI (>32 points) with a sensitivity of 67.5% and a specificity of 88.9%.

Conclusion: The above-suggested criteria can be added to routine diagnostic procedures to confirm MI in MIS-C patients.

Keywords: children; coronary artery lesions; cytokine storm syndrome; hypercytokine syndrome; multisystem inflammatory syndrome; myocarditis; shock; troponin.

Copyright © 2022 Kostik, Bregel, Avrusin, Efremova, Belozerov, Dondurei, Kornishina, Isupova, Abramova, Felker, Masalova, Santimov, Kozlov, Barakin, Snegireva, Konstantinova, Vilnits, Bekhtereva, Argunova, Matyunova, Sleptsova, Burtseva, Shprakh, Boyko, Kalashnikova and Chasnyk.