Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe
Authors: Valverde Israel , Singh Yogen , Sanchez-de-Toledo Joan , Theocharis Paraskevi , Chikermane Ashish , Di Filippo Sylvie , Kuciñska Beata , Mannarino Savina , Tamariz-Martel Amalia , Gutierrez-Larraya Federico , Soda Giridhar , Vandekerckhove Kristof , Gonzalez-Barlatay Francisco , McMahon Colin Joseph , Marcora Simona , Napoleone Carlo Pace , Duong Phuoc , Tuo Giulia , Deri Antigoni , Nepali Gauri , Ilina Maria , Ciliberti Paolo , Miller Owen , Iriart Xavier , Hubrechts Jelena , Kuipers Irene Mariette , Sousa Ana R. , Donti Andrea , Sharpe Abigail , Reinhardt Zdenka , Cairello Francesca , De Wolf Daniel , Vieira Marisa , Lazea Cecilia , Gran Ferran , Medrano-Lopez Constancio , Ortiz-Garrido Almudena , Vukomanovic Vladislav , Brent Bernadette Elisabeth , Milanesi Ornella , Dewals Wendy , Manso Begoña , Valsangiacomo-Buchel Emanuela , Francisco Andreia , Seghaye Marie-Christine , Loeckx Isabelle , Rodriguez-Gonzalez Moises , ReyGarcía Susana Maria , Ziesenitz Victoria C , Bordin Giulia , Doros Gabriela , Grangl Gernot , Fadl Shalan Uaid , Perminow Karl Viktor , Centeno Fernando , Pinto Fatima , Niemelä Jussi , Kanthimathinathan Hari Krishnan , Randanne Paula Cecilia , Niszczota Cezary , Zuccotti Gian Vincenzo , Gordillo Inés Leoz , Obeyasekhara Madhu , Armstrong Catherine , Butler Karina , Ciuffreda Matteo , Villar Anna Maria , Pappula Naga , Caorsi Roberta , Singh Davinder , Durairaj Saravanan , McLeod Karen , Calcagni Giulio , Quizad Youssef , Gewillig Marc , Kuijpers Taco Willem , Ataide Rita , Fabi Marianna , Bharucha Tara , Abbas Khushnood , Magrass Silvia Alessandra , Wong James , Iacob Daniela , Balcells Joan , GilVillanueva Nuria , Cuenca-Peiro Victorio , Cerovi Ivana , Sarfatt Avishay , Zaqout Mahmoud , Sanchez-Valderrabanos Elia , Kelly-Geyer Janet , Diogo Faim , Cajgfinger Nathalie , Françoise Mascart , Rueda-Nuñez Fernando , Gorenflo Matthias , Grison Alessandra , Mihailov Delia , Koestenberger Martin , Alcalde Carlos , Trigo Conceiçao , Arola Anita , Hanseus Katarina 
Published: November 2020

Background:
The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection.

Methods:
This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included.

Results:

A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8–12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (
P
<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died.

Conclusions:
Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.