Analysis of cardiac manifestation and treatment of multisystem inflammatory syndrome in children related to SARS-CoV-2

Cardiovascular manifestations are common (35–100%) in the multisystem inflammatory syndrome in children. Our study aimed to analyze treatment impact and cardiovascular involvement in patients with multisystem inflammatory syndrome in children. The retrospective cohort included 81 patients treated between April 2020 and December 2021 (9.3±4.6 years). Elevated cardiac troponin I and pro-B-type natriuretic peptide were observed in 34.2% and 88.5% of patients, respectively. Myocardial dysfunction was observed in 50.6%. Children older than 10 years had a 4-fold increased risk of myocardial dysfunction (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.4-8.9; p=0.006). A moderate negative correlation was proved between left ventricle ejection fraction and C-reactive protein (rr = - 0.48; p < 0.001). More than one-fifth of the patients presented with shock. Coronary artery dilatation was observed in 6.2% of patients. Mild pericardial effusion was detected in 27.1% of children. On standard electrocardiogram, 52.6% of children had negative T waves in the inferior and/or precordial leads; transient QTc prolongation was registered in 43% of patients. Treatment failure was observed in 19 patients. Patients initially treated with intravenous immunoglobulins had 10-fold higher chances for treatment failure than patients treated with corticosteroids (OR 10.6, 95% CI 3,18 – 35.35; p < 0.001). Cardiovascular manifestations were observed in more than half of the patients, with acute myocardial dysfunction being the most common, especially in children older than 10 years. We established a negative association between the degree of elevation of inflammatory markers and left ventricular ejection fraction. Patients treated with intravenous immunoglobulins who had cardiovascular manifestations had treatment failures more frequently than patients treated with corticosteroids

Does Colchicine Substitute Corticosteroids in Treatment of Idiopathic and Viral Pediatric Pericarditis?

Background and Objectives: Recurrence of pericarditis (ROP) is an important complication of the acute pericarditis. The aim of this study was to analyse the influence of aetiology, clinical findings and treatment on the outcome of acute pericarditis. Methods: Data were retrospectively collected from medical records of patients treated from 2011 to 2019 at a tertiary referent heart paediatric center. Results: Our investigation included 56 children with idiopathic and viral pericarditis. Relapse was registered in 8/56 patients, 2/29 (7.41%) treated with nonsteroidal anti-inflammatory drugs (NSAID) and 6/27 (28.57%) treated with corticosteroids (CS) and NSAID. Independent risk factors for ROP were viral pericarditis (p = 0.01, OR 31.46), lack of myocardial affection (p = 0.03, OR 29.15), CS use (p = 0.02, OR 29.02) and ESR &ge; 50 mm/h (p = 0.03, OR 25.23). In 4/8 patients the first recurrence was treated with NSAID and colchicine, while treatment of 4/8 patients included CS. Children with ROP treated with CS had higher median number of recurrence (5, IQR: 2&ndash;15) than those treated with colchicine (0, IQR: 0&ndash;0.75). Conclusions: Independent risk factors for recurrence are CS treatment, viral aetiology, pericarditis only and ESR &ge; 50 mm/h. Acute pericarditis should be treated with NSAID. Colchicine and NSAID might be recommended in children with the first ROP

THE INFLUENCE OF EARLY LEFT VENTRICLE REMODELING OVER QTC CHANGES IN HIGHLY TRAINED PREADOLESCENT FOOTBALLERS

Aim. To assess the correlation between left ventricle remodeling induced by physical training with QTc duration in preadolescent professional football players.Material and methods. Ninety-four highly trained male footballers (mean aged 12,85±0,84) competing in the Serbian Football League (at least 7 training hours/ week) and 47 age-matched healthy male controls were enrolled in the study. Main outcome measures: They were screened by ECG and echocardiography at a tertiary referral cardio center. The control group had sedentary life style (less than 2 training hours/week). QTc values and left ventricle dimensions were compared in these two groups.Results. In all participants, normal values of QTc interval were registered. Mean QTc in athletes was significantly higher compared to non-athletes (419,89±13,07 msec vs 399,78±13,27 msec) (p&lt;0,001). QTc interval had strong positive correlation to left atrium dilatation, LV dilatation, LV mass and LV mass index. There was no correlation between QTc interval and LV wall thickness, but there were correlations between QTc interval duration and specific LV mass indexes (LVM/BSA 1,5 and LVM/h 2.7).Conclusion. QTc interval prolongation is present in early stage of athlete’s heart remodeling, hence QTc prolongation could be the early ECG marker of physiological LV remodeling in young preadolescent footballers, without any other standard ECG and echocardiographic signs of early LV hypertrophy. This could be explained by a different pattern of left ventricle remodeling in preadolescent period, where LV wall thickness increase cannot usually be seen and the predominant characteristic is left ventricle dilatation

Fit-for-Purpose Quality Control System in Continuous Bioanalysis during Long-Term Pediatric Studies (vol 21, 104, 2019)

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