Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemi - 14/08/21
, Mathilde Méot 1, Fanny Bajolle 1, Diala Khraiche 1, Antoine Legendre 1, Samya Abakka 1, Johanne Auriau 1, Marion Grimaud 1, Mehdi Oualha 1, Maurice Beghetti 3, Julie Wacker 3, Caroline Ovaert 4, 5, Sebastien Hascoet 6, Maëlle Selegny 7, Sophie Malekzadeh-Milani 1, Alice Maltret 1, Gilles Bosser 8, Nathan Giroux 8, Laurent Bonnemains 9, Jeanne Bordet 9, Sylvie Di Filippo 10, Pierre Mauran 11, Sylvie Falcon-Eicher 12, Jean-Benoît Thambo 13, Bruno Lefort 14, Pamela Moceri 15, Lucile Houyel 1, 2, Sylvain Renolleau 1, 2, Damien Bonnet 1
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Résumé |
Background |
Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention.
Methods |
Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state.
Results |
Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2–16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135pg/mL) and macrophage activation (D-dimer median, 5284ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned.
Conclusions |
Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.
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| ☆ | Due to the pandemic, this abstract was already published in Circulation, https://doi.org/10.1161/CIRCULATIONAHA.120.048360. |
Vol 13 - N° 4
P. 271 - septembre 2021 Retour au numéro
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