Myocardial involvement in children with post-COVID multisystem inflammatory syndrome: a cardiovascular magnetic resonance based multicenter international study—the CARDOVID registry

Journal of Cardiovascular Magnetic Resonance

Francesca Ferroni¹  Gabriella Agnoletti¹  Simona Marcora²  James Wong³  Beate Rücker³  Kuberan Pushparajah⁴  Florence A. Aeschlimann⁵  Jeremy M. Steele⁶  Steffen Huber⁷  Giovanni Di Salvo⁸  Annachiara Cavaliere⁸  Supriya Jain⁹  Kimberly Crum^1,10  Jonathan H. Soslow^1,10  Mehul D. Patel^1,11  Nilanjana Misra^1,12  Pablo Caro-Domínguez^1,13  Laurent Bonnemains^1,14  Duarte Martins^1,15  Valentina Giuli^1,16  Tarique Hussein^1,17  Nathalie Boddaert^1,18  Elena Panaioli^1,19  Francesca Raimondi^2,20  Paolo Brambilla^2,21  Arshid Azarine^2,22  Maria Navallas^2,23  Felix Angst^2,24 

[1] Cardiology Department, Regina Margherita Children’s Hospital, Turin, Italy;Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy;Department of Paediatric Cardiology, Evelina London Children’s Hospital, London, UK;Department of Paediatric Cardiology, Evelina London Children’s Hospital, London, UK;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK;Department of Pediatric Immunology-Hematology and Rheumatology, Hôpital Necker Enfants Malades, Paris, France;Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA;Department of Radiology, Yale University School of Medicine, New Haven, CT, USA;Department of Women’s and Children’s Health, University of Padua, Padua, Italy;Division of Pediatric Cardiology, Department of Pediatrics, New York Medical College, Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, NY, USA;Division of Pediatric Cardiology, Thomas P Graham Jr, Vanderbilt University Medical Center, Nashville, TN, USA;Division of Pediatric Cardiology, University of Texas Health Science Center, Houston, TX, USA;Division of Pediatric Cardiology, Zucker School of Medicine, Cohen Children’s Medical Center of NY, Northwell Health, New York, USA;Imagen Pediatrica, Hospital Universitario Virgen del Rocío, Sevilla, Spain;Paediatric Cardiology, University Hospital of Strasbourg, Strasbourg, France;ICube, Équipe MecaFlu, UMR 7357, University of Strasbourg, Strasbourg, France;Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal;Pediatric Cardiology, Niguarda Hospital, Milan, Italy;Pediatric Cardiology, UT Southwestern, Dallas, TX, USA;Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France;Institut Imagine, Paris, France;Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France;Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France;Pediatric Radiology, Hôpital Necker Enfants Malades, Université de Paris, Paris, France;Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Maladies Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, 149, Rue de Sèvres, 75743, Paris, France;Institut Imagine, Paris, France;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK;Decision and Bayesian Computation, Computation Biology Department, CNRS, URS 3756, Neuroscience Department, CNRS UMR 3571, Institut Pasteur, Paris, France;Radiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy;Radiology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France;Radiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain;Research Department, Rehaklinik Bad Zurzach, Zurzach Care Group, Bad Zurzach, Switzerland;

关键词: SARS Cov-2 infection;    CMR;    Acute myocarditis;    Children;    MIS-C;   

DOI  :  10.1186/s12968-021-00841-1

来源: Springer

【 摘 要 】

BackgroundRecent evidence shows an association between coronavirus disease 2019 (COVID-19) infection and a severe inflammatory syndrome in children. Cardiovascular magnetic resonance (CMR) data about myocardial injury in children are limited to small cohorts. The aim of this multicenter, international registry is to describe clinical and cardiac characteristics of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 using CMR so as to better understand the real extent of myocardial damage in this vulnerable cohort.Methods and resultsHundred-eleven patients meeting the World Health Organization criteria for MIS-C associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having clinical cardiac involvement and having received CMR imaging scan were included from 17 centers. Median age at disease onset was 10.0 years (IQR 7.0–13.8). The majority of children had COVID-19 serology positive (98%) with 27% of children still having both, positive serology and polymerase chain reaction (PCR). CMR was performed at a median of 28 days (19–47) after onset of symptoms. Twenty out of 111 (18%) patients had CMR criteria for acute myocarditis (as defined by the Lake Louise Criteria) with 18/20 showing subepicardial late gadolinium enhancement (LGE). CMR myocarditis was significantly associated with New York Heart Association class IV (p = 0.005, OR 6.56 (95%-CI 1.87–23.00)) and the need for mechanical support (p = 0.039, OR 4.98 (95%-CI 1.18–21.02)). At discharge, 11/111 (10%) patients still had left ventricular systolic dysfunction.ConclusionNo CMR evidence of myocardial damage was found in most of our MIS-C cohort. Nevertheless, acute myocarditis is a possible manifestation of MIS-C associated with SARS-CoV-2 with CMR evidence of myocardial necrosis in 18% of our cohort. CMR may be an important diagnostic tool to identify a subset of patients at risk for cardiac sequelae and more prone to myocardial damage.Clinical trial registration: The study has been registered on ClinicalTrials.gov, Identifier NCT04455347, registered on 01/07/2020, retrospectively registered.

【 授权许可】

CC BY