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Cardiac outcomes in severe acute respiratory syndrome coronavirus-2-associated multisystem inflammatory syndrome at a tertiary paediatric hospital

Part of: Infectious

Published online by Cambridge University Press:  10 December 2021

Filip Kucera ,
Craig Laurence Open the ORCID record for Craig Laurence [Opens in a new window] ,
Jacob Simmonds ,
Javier Gavela ,
Tetyana Bodnar ,
Paul Brogan ,
Aparna Hoskote ,
Sophie Skellett ,
Karyn Moshal  and
Alasdair Bamford
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Filip Kucera*
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Craig Laurence
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Jacob Simmonds
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Javier Gavela
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Tetyana Bodnar
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Paul Brogan
Affiliation:
Department of Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK Institute of Child Health, University College London, London, UK
Aparna Hoskote
Affiliation:
Cardiac Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Sophie Skellett
Affiliation:
Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Karyn Moshal
Affiliation:
Infectious Diseases Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Alasdair Bamford
Affiliation:
Infectious Diseases Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
Sachin Khambadkone
Affiliation:
Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
*
Author for correspondence: Dr F. Kucera, MD, Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, LondonWC1N 3JH, UK. Tel: 020 7405 9200. E-mail: Filip.Kucera@gosh.nhs.uk
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Abstract

Introduction:

We describe a cohort of children referred with multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 and compare this cohort with a 2019 cohort of children with Kawasaki disease.

Methods:

We conducted a retrospective cohort study of 2019 and 2020 referrals to the inflammatory cardiology service at Great Ormond Street Hospital for Children. We compared cardiac and inflammatory parameters of a sub-section of the 2020 cohort who presented with reduced left ventricular ejection fraction with the remainder of the cohort.

Results:

Referrals significantly increased between February and June 2020 compared to 2019 (19.8/30 days versus 3.9/30 days). Frequency of coronary artery aneurysms (11/79 (13.9%) versus 7/47 (14.9%)) or severe coronary artery aneurysms (6/79 (7.6%) versus 3/47 (6.4%)) was similar between 2020 and 2019, respectively. The 2020 cohort was older (median age 9.07 years versus 2.38 years), more likely to be of Black, Asian, or other minority ethnic group (60/76 (78.9%) versus 25/42 (59.5%)), and more likely to require inotropic support (22 (27.5%) versus 0 (0%)). Even children with significantly reduced left ventricular ejection fraction demonstrated complete recovery of cardiac function within 10 days (mean 5.25 days ± 2.7).

Discussion:

We observed complete recovery of myocardial dysfunction and an overall low rate of permanent coronary sequelae, indicating that the majority of children with multisystem inflammatory syndrome in children are unlikely to encounter long-term cardiac morbidity. Although the frequency of myocardial dysfunction and inotropic support requirement is not consistent with a diagnosis of Kawasaki disease, the frequency of coronary artery abnormalities and severe coronary artery abnormalities suggests a degree of phenotypic overlap.

Keywords

COVID-19Kawasaki diseaseinflammatorymyocarditiscoronary artery aneurysm
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1585 - 1591
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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