Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID-19 Infections.
Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID-19 Infections.
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DOI：
10.1161/jaha.121.023251
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发表时间：
2022-03
影响因子：
5.4
通讯作者：
Banerjee, Anirban
中科院分区：
文献类型：
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作者：
Matsubara, Daisuke;Chang, Joyce;Kauffman, Hunter L.;Wang, Yan;Nadaraj, Sumekala;Patel, Chandni;Paridon, Stephen M.;Fogel, Mark A.;Quartermain, Michael D.;Banerjee, Anirban
关键词：
在儿童多系统炎性综合征中，缺乏关于心脏结局的纵向数据。我们使用超声心动图和心脏磁共振成像分析了初次就诊后3至4个月的心脏结局。我们包括60名对照组和60例多系统炎症综合征患儿。在4个时间点分析常规超声心动图和变形参数：（1）急性期（n=60），（2）亚急性期（n=50;中位数，初始超声心动图后3天），（3）1个月随访（n=39;中位数，22天），（4）3 - 4个月随访（n=25;中位数，91天）。在亚急性（n=5）和随访（n=9）阶段审查了14项连续心脏磁共振成像研究的心肌水肿或纤维化。在急性期，心肌损伤定义为肌钙蛋白I水平≥0.09 ng/mL（>正常值的3倍）或脑型利钠肽>800 pg/mL。所有变形参数，包括左心室整体纵向应变、左心房峰值应变、纵向舒张早期应变率和右心室游离壁应变，在第一周内迅速恢复，随后持续改善并在3个月时完全正常化。整体纵向应变和左心房应变恢复正常的中位时间为6天（95% CI，3-9天）。就诊时心肌损伤（儿童病例中70%的多系统炎症综合征）不影响短期结局。4例患者（7%）就诊时有小冠状动脉瘤，均已消退。9例患者中仅1例有残余水肿，但心脏磁共振成像显示无纤维化。我们的短期研究表明，儿童多系统炎症综合征的功能恢复和冠状动脉结局良好。使用敏感的变形参数进一步保证了3个月后没有持续的亚临床功能障碍。
In multisystem inflammatory syndrome in children, there is paucity of longitudinal data on cardiac outcomes. We analyzed cardiac outcomes 3 to 4 months after initial presentation using echocardiography and cardiac magnetic resonance imaging. We included 60 controls and 60 cases of multisystem inflammatory syndrome in children. Conventional echocardiograms and deformation parameters were analyzed at 4 time points: (1) acute phase (n=60), (2) subacute phase (n=50; median, 3 days after initial echocardiography), (3) 1‐month follow‐up (n=39; median, 22 days), and (4) 3‐ to 4‐month follow‐up (n=25; median, 91 days). Fourteen consecutive cardiac magnetic resonance imaging studies were reviewed for myocardial edema or fibrosis during subacute (n=5) and follow‐up (n=9) stages. In acute phase, myocardial injury was defined as troponin‐I level ≥0.09 ng/mL (>3 times normal) or brain‐type natriuretic peptide >800 pg/mL. All deformation parameters, including left ventricular global longitudinal strain, peak left atrial strain, longitudinal early diastolic strain rate, and right ventricular free wall strain, recovered quickly within the first week, followed by continued improvement and complete normalization by 3 months. Median time to normalization of both global longitudinal strain and left atrial strain was 6 days (95% CI, 3–9 days). Myocardial injury at presentation (70% of multisystem inflammatory syndrome in children cases) did not affect short‐term outcomes. Four patients (7%) had small coronary aneurysms at presentation, all of which resolved. Only 1 of 9 patients had residual edema but no fibrosis by cardiac magnetic resonance imaging. Our short‐term study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children. Use of sensitive deformation parameters provides further reassurance that there is no persistent subclinical dysfunction after 3 months.