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Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 113

Myocardial damage in multisystem inflammatory syndrome associated with COVID-19 in children and adolescents

1 Department of Cardiology, Mother and Child Health Institute of Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
2 Department of Cardiology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
3 Department of Immunology, Mother and Child Health Institute of Serbia, Belgrade, Serbia
4 Intensive Care Unit, Mother and Child Health Institute of Serbia, Belgrade, Serbia
5 Institute of Medical Physiology “Rihard Burian”, Belgrade, Serbia

Correspondence Address:
Prof. Vladislav Vukomanovic
Mother and Child Health Care Institute of Serbia “Dr. Vukan Cupic”, R. Dakica St. 6-8, 11070 Belgrade, Serbia. School of Medicine, University of Belgrade, Serbian Representative in AEPC, Belgrade
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrms.JRMS_1195_20

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Background: In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported. Materials and Methods: A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed. Results: Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms. Conclusions: With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period.

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