Cardiac evaluation of hospitalized children with 2019 coronavirus (COVID-19) infection at a single large quaternary center
Qimin Ng,
Yue-Hin Loke,
Karen L. Smith,
Roberta L. DeBiasi,
Charles I. Berul,
Matthew P. Sharron,
David Wessel,
James E. Bost,
Robert W. Lowndes,
Emily Ansusinha,
Kristine Mehrtens,
John Schultz,
Ashraf S. Harahsheh
Affiliations
Qimin Ng
Pediatric Residency Program, Medstar Georgetown University Hospital, Washington, DC, USA
Yue-Hin Loke
Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Karen L. Smith
Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Division of Hospital Medicine, Children's National Hospital, Washington, DC, USA
Roberta L. DeBiasi
Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Charles I. Berul
Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Matthew P. Sharron
Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
David Wessel
Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
James E. Bost
Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Division of Biostatistics, Children's National Hospital, Washington, DC, USA
Robert W. Lowndes
Division of Cardiology, Children's National Hospital, Washington, DC, USA
Emily Ansusinha
Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
Kristine Mehrtens
Division of Cardiology, Children's National Hospital, Washington, DC, USA
John Schultz
Division of Ambulatory Services, Children's National Hospital, Washington, DC, USA
Ashraf S. Harahsheh
Division of Cardiology, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Corresponding author. Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Background: Cardiac complications of serious SARS-CoV-2 infections, especially Multisystem Inflammatory Syndrome of Children (MIS-C) are well described, however current studies have not considered pediatric patients hospitalized with no cardiac concerns. We established a protocol for cardiac evaluation of all admitted COVID-19 patients three weeks post-discharge, irrespective of cardiac concerns. We assessed cardiovascular outcomes and hypothesized that patients with absent cardiac concerns are at lower risk for cardiac abnormalities. Methods: This was a retrospective study of 160 patients admitted for COVID-19 (excluding MIS-C) between March 2020 and September 2021 with subsequent echocardiogram(s) performed at our center. Patients were divided into 4 subgroups: Group 1 included patients with absent cardiac concerns, admitted to acute care (1a) and intensive care unit (ICU) (1 b). Group 2 included patients with cardiac concerns, admitted to acute care (2a) and ICU (2 b). Groups were compared based on clinical endpoints and echocardiographic measurements, including tissue Doppler imaging (TDI) assessment of diastolic function (z-score of septal Mitral E/TDI E′ and lateral E/TDI E′). Chi-squared, Fisher's exact, and Kruskal-Wallis tests were used. Results: Traditional cardiac abnormalities varied significantly between the groups; with Group 2 b having the most (n = 8, 21%), but still found in Group 1a (n = 2, 3%) and Group 1 b (n = 1, 5%). No patients in Group 1 demonstrated abnormal systolic function, compared to Group 2a (n = 1, 3%) and Group 2 b (n = 3, 9%, p = 0.07). When including TDI assessment of diastolic function, the total incidence of abnormalities found on echocardiogram was increased in all groups. Conclusion: Cardiac abnormalities were found in pediatric patients admitted with COVID-19, even those without apparent cardiovascular concerns. The risk was greatest in ICU-admitted patients with cardiac concerns. The clinical significance of diastolic function assessment in these patients remains unknown. Further studies are needed to assess long-term cardiovascular sequelae of children with COVID-19, irrespective of cardiac concerns.
