Cardiovascular repercussions resulting from the Multisystem Inflammatory Syndrome after COVID-19 infection in pediatric age: an integrative review
DOI:
https://doi.org/10.33448/rsd-v11i5.28776Keywords:
Inflammatory Multisystem Syndrome; Pediatrics; COVID-19; Cardiology; Teaching.Abstract
The pediatric population constitutes only 2% of COVID-19 cases, however, cases of inflammatory shock, ventricular dysfunction and thrombotic events have been reported. This set of signs is called Multisystem Inflammatory Syndrome (MIS-C), also characterized by hyperpyrexia and generalized organ failure, with a direct relationship with SARS-COV-2 infection. The present work aims to synthesize the evidence of cardiovascular manifestations resulting from the Post COVID-19 Multisystem Inflammatory Syndrome in pediatric age (PMIS-TS). For this Integrative Review, carried out through the PubMed and Science Direct platforms between 2020 and 2022, the descriptors elected were ''Inflammation'', ''Pediatrics'', ''Covid-19'' and ''Cardiology'', associated to the Boolean operator ''AND''. Inclusion criteria consisted of (1) clinical trials, controlled and randomized trials, reviews and meta-analyses; (2) studies on the cardiovascular repercussions of PMIS-TS; (3) studies on pediatric cardiomyopathies resulting from coronavirus infection; (4) articles on management and treatment of PMIS-TS. Exclusion criteria included inadequacies to the topic, assessments of other clinical conditions, in addition to non-specific texts when addressing MIS-C. It was observed that the cases of PMIS-TS had echocardiograms and magnetic resonance imaging predictive of myocarditis, valvulitis and coronary heart disease, findings corroborated by laboratory alterations. The electrocardiograms included premature beats and various arrhythmias. In the analysis of the 54 articles, it was identified that, despite the pediatric age group corresponding to the smallest share of COVID-19 cases, children are susceptible to potentially serious repercussions. Thus, the hyper-inflammatory state can lead to death, and it is essential to conduct new studies with assertive therapeutic options for the aforementioned conditions.
References
Alcindor, M. L., Alcindor, F., Richard, K. E., Ajay, G., Denis, A. M., Dickson, D. M., & Allen, D. (2021). COVID-19 Management in Pediatrics. JNP., 17(5), 528-535.
Alsaied, T., Tremoulet, A. H., Burns, J. C., Saidi, A., Dionne, A., Lang, S. M., & Friedman, K. G. (2021). Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation, 143(1), 78-88.
Barach, P., & Lipshultz, S. E. (2020). Rethinking COVID-19 in children: lessons learned from pediatric viral and inflammatory cardiovascular diseases. PPC, 57, 101233.
Blatz, A., & Randolph, A. (2022). Severe COVID-19 and MIS-C In Children & Adolescents. Crit Care Clin.
Bogiatzopoulou, A., Mayberry, H., Hawcutt, D. B., Whittaker, E., Munro, A., Roland, D., & Harwood, R. (2020). COVID-19 in children: what did we learn from the first wave?. PCH, 30(12), 438-443.
Bucciarelli, V., Nasi, M., Bianco, F., Seferovic, J., Ivkovic, V., Gallina, S., & Mattioli, A. V. (2021). Depression pandemic and cardiovascular risk in the COVID-19 era and long COVID syndrome: gender makes a difference. Trends Cardiovasc. Med.
Case, S. M., & Son, M. B. (2021). COVID-19 in Pediatrics. Rheum Dis Clin North Am., 47(4), 797-811.
da Paz Silva Filho, P. S., Osternes, F. N. D., Balsamo, A. C. M., Kirchesch, C. L., da Cruz, E. S., Santos, T. C. S., & da Silva Caetano, V. (2020). Insuficiência cardíaca relacionada a infecção por COVID-19: com ênfase em idosos. RSD, 9(9), e397997307-e397997307.
DeBiasi, R. L., Harahsheh, A. S., Srinivasalu, H., Krishnan, A., Sharron, M. P., Parikh, K., & Bard, J. D. (2021). Multisystem inflammatory syndrome of children: subphenotypes, risk factors, biomarkers, cytokine profiles, and viral sequencing. J Pediat., 237, 125-135.
Dionne, A., Son, M. B. F., & Randolph, A. G. (2022). An Update on Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. PIDJ., 41(1), e6.
dos Santos, L. E. S., & dos Santos, L. S. (2021). O impacto do coronavírus em pacientes cardiopatas. RSD, 10(5), e0110514539-e0110514539.
Dufort, E. M., Koumans, E. H., Chow, E. J., Rosenthal, E. M., Muse, A., Rowlands, J., & Zucker, H. (2020). Multisystem inflammatory syndrome in children in New York State. NEJM., 383(4), 347-358.
Edwards, J. J., Harris, M. A., Toib, A., Burstein, D. S., & Rossano, J. W. (2022). Asymmetric septal edema masking as hypertrophy in an infant with COVID-19 myocarditis. PPC, 64, 101464.
El-Assaad, I., Hood-Pishchany, M. I., Kheir, J., Mistry, K., Dixit, A., Halyabar, O., & Cheng, H. (2020). Complete heart block, severe ventricular dysfunction, and myocardial inflammation in a child with COVID-19 infection. JACC: Case Reportsms, 2(9), 1351-1355.
Elias, M. D., McCrindle, B. W., Larios, G., Choueiter, N. F., Dahdah, N., Harahsheh, A. S., & Dionne, A. (2020). Management of multisystem inflammatory syndrome in children associated with COVID-19: a survey from the International Kawasaki Disease Registry. Cjc Open, 2(6), 632-640.
Emeksiz, S., Çelikel Acar, B., Kibar, A. E., Özkaya Parlakay, A., Perk, O., Bayhan, G. İ., & Şenel, E. (2021). Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID‐19. Int J Clin Pract., 75(9), e14471.
Evans, C., & Davies, P. (2021). SARS-CoV-2 paediatric inflammatory syndrome. PCH, 31(3), 110-115.
Felsenstein, S., Duong, P., Lane, S., Jones, C., Pain, C. E., & Hedrich, C. M. (2021). Cardiac pathology and outcomes vary between Kawasaki disease and PIMS-TS. Clin. Immunol., 229, 108780.
Fialkowski, A., Gernez, Y., Arya, P., Weinacht, K. G., Kinane, T. B., & Yonker, L. M. (2020). Insight into the pediatric and adult dichotomy of COVID‐19: age‐related differences in the immune response to SARS‐CoV‐2 infection. Pediatr. Pulmonol., 55(10), 2556-2564.
Friedman, K. G., Harrild, D. M., & Newburger, J. W. (2020). Cardiac dysfunction in multisystem inflammatory syndrome in children: a call to action. JAACC, 76(17), 1962-1964.
Geva, A., Patel, M. M., Newhams, M. M., Young, C. C., Son, M. B. F., Kong, M., & Overcoming COVID-19 Investigators. (2021). Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents. eClinicalMedicine., 40, 101112.
Güllü, U. U., Güngör, Ş., İpek, S., Yurttutan, S., & Dilber, C. (2021). Predictive value of cardiac markers in the prognosis of COVID-19 in children. The Am J Emerg Med., 48, 307-311.
Harwood, R., Allin, B., Jones, C. E., Whittaker, E., Ramnarayan, P., Ramanan, A. V., & Yardley, I. (2021). A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process. Lancet Child Adolesc. Health.., 5(2), 133-141.
Hejazi, O. I., Loke, Y. H., & Harahsheh, A. S. (2021). Short-term Cardiovascular Complications of Multi-system Inflammatory Syndrome in Children (MIS-C) in Adolescents and Children. Curr. Pediatr. Rep., 9(4), 93-103.
Hennon, T. R., Karl, O. A., Penque, M. D., Abdul-Aziz, R., Chang, A. C., McGreevy, M. B., & Hicar, M. D. (2021). COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves. PPC, 62, 101407.
Holstein, B. (2021). Multisystem Inflammatory Syndrome in Children. JNP, 17(8), 941-945.
Imazio, M., Klingel, K., Kindermann, I., Brucato, A., De Rosa, F. G., Adler, Y., & De Ferrari, G. M. (2020). COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis?. Heart, 106(15), 1127-1131.
Jain, S., Nolan, S. M., Singh, A. R., Lovig, L., Biller, R., Kamat, A., & Gewitz, M. H. (2020). Myocarditis in multisystem inflammatory syndrome in children associated with coronavirus disease 2019. Cardiol Rev., 28(6), 308-311.
Jiang, L., Tang, K., Levin, M., Irfan, O., Morris, S. K., Wilson, K., & Bhutta, Z. A. (2020). COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect. Dis. Journal, 20(11), e276-e288.
Kaushik, S., Aydin, S. I., Derespina, K. R., Bansal, P. B., Kowalsky, S., Trachtman, R., & Medar, S. S. (2020). Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York City. J Pediatr, 224, 24-29.
Kiss, A., Ryan, P. M., & Mondal, T. (2021). Management of COVID-19-associated multisystem inflammatory syndrome in children: A comprehensive literature review. PPC, 63, 101381.
Kline, J. N., Isbey, S. C., McCollum, N. L., Falk, M. J., Gutierrez, C. E., Guse, S. E., & Breslin, K. A. (2022). Identifying pediatric patients with multisystem inflammatory syndrome in children presenting to a pediatric emergency department. Am J Emerg Med.., 51, 69-75.
Kobayashi, R., Dionne, A., Ferraro, A., Harrild, D., Newburger, J., VanderPluym, C., & Friedman, K. G. (2021). Detailed Assessment of Left Ventricular Function in Multisystem Inflammatory Syndrome in Children, Using Strain Analysis. CJC open, 3(7), 880-887.
Kohli, U., Meinert, E., Chong, G., Tesher, M., & Jani, P. (2020). Fulminant myocarditis and atrial fibrillation in child with acute COVID-19. J Electrocardiol.
Lamrani, L., Manlhiot, C., Elias, M. D., Choueiter, N. F., Dionne, A., Harahsheh, A. S., & Dahdah, N. (2021). Kawasaki Disease Shock Syndrome vs Classical Kawasaki Disease: A Meta-analysis and Comparison With SARS-CoV-2 Multisystem Inflammatory Syndrome. CJC, 37(10), 1619-1628.
Loke, Y. H., Berul, C. I., & Harahsheh, A. S. (2020). Multisystem inflammatory syndrome in children: is there a linkage to Kawasaki disease?. Trends Cardiovasc. Med., 30(7), 389-396.
Loomba, R. S., Villarreal, E. G., & Flores, S. (2020). COVID-19 and hyperinflammatory syndrome in children: Kawasaki disease with macrophage activation syndrome in disguise?. Curēus, 12(8).
Malviya, A., & Mishra, A. (2021). Childhood multisystem inflammatory syndrome: an emerging disease with prominent cardiovascular involvement—a scoping review. SN Compr Clin Med., 3(1), 48-59.
Marino, A., Varisco, T., Quattrocchi, G., Amoroso, A., Beltrami, D., Venturiello, S., & Cimaz, R. (2021). Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review. Reumatismo, 73(1), 48-53.
Matsubara, D., Kauffman, H. L., Wang, Y., Calderon-Anyosa, R., Nadaraj, S., Elias, M. D., & Banerjee, A. (2020). Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. JACC, 76(17), 1947-1961.
Niaz, T., Hope, K., Fremed, M., Misra, N., Altman, C., Glickstein, J., & Chowdhury, D. (2021). Role of a pediatric cardiologist in the COVID-19 pandemic. Pediatr Cardiol, 42(1), 19-35.
Prata-Barbosa, A., Lima-Setta, F., Santos, G. R. D., Lanziotti, V. S., Castro, R. E. V. D., Souza, D. C. D., & Magalhães-Barbosa, M. C. D. (2020). Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J), 96, 582-592.
Penner, J., Abdel-Mannan, O., Grant, K., Maillard, S., Kucera, F., Hassell, J., & Papadopoulou, C. (2021). 6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study. Lancet Child Adolesc. Health, 5(7), 473-482.
Petersen, S. E., Friedrich, M. G., Leiner, T., Elias, M. D., Ferreira, V. M., Fenski, M., & Bluemke, D. A. (2021). Cardiovascular magnetic resonance for patients with COVID-19. JACC: Cardiovascular Imaging.
Regan, W., O’Byrne, L., Stewart, K., Miller, O., Pushparajah, K., Theocharis, P., & Rosenthal, E. (2021). Electrocardiographic changes in children with multisystem inflammation associated with COVID-19: associated with coronavirus disease 2019. J Pediatr, 234, 27-32.
Rimensberger, P. C., Kneyber, M. C., Deep, A., Bansal, M., Hoskote, A., Javouhey, E., & Brierley, J. (2021). Caring for critically ill children with suspected or proven coronavirus disease 2019 infection: recommendations by The Scientific Sections’ Collaborative of The European Society of Pediatric and Neonatal
Intensive Care. PCCM, 22(1), 56.
Sanil, Y., Misra, A., Safa, R., Blake, J. M., Eddine, A. C., Balakrishnan, P., & Singh, G. (2021). Echocardiographic indicators associated with adverse clinical course and cardiac sequelae in multisystem inflammatory syndrome in children with coronavirus disease 2019. JASE, 34(8), 862-876.
Sharma, C., Ganigara, M., Galeotti, C., Burns, J., Berganza, F. M., Hayes, D. A., & Bayry, J. (2021). Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat. rev., Rheumatol., 17(12), 731-748.
Simpson, M., Collins, C., Nash, D. B., Panesar, L. E., & Oster, M. E. (2020). Coronavirus disease 2019 infection in children with pre-existing heart disease. J Pediat, 227, 302-307.
Sperotto, F., Friedman, K. G., Son, M. B. F., VanderPluym, C. J., Newburger, J. W., & Dionne, A. (2021). Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. EJPE, 180(2), 307-322.
Thrift, K. C., Withycombe, J. S., & Temples, H. S. (2021). Is it Kawasaki Disease or Multisystem Inflammatory Syndrome in Children?. JNP, 17(10), 1230-1236.
Torres, J. P., Izquierdo, G., Acuña, M., Pavez, D., Reyes, F., Fritis, A., & Tapia, L. I. (2020). Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. IJID, 100, 75-81.
Truong, D. T., Trachtenberg, F. L., Pearson, G. D., Dionne, A., Elias, M. D., Friedman, K., & Chrisant, M. (2022). The NHLBI Study on Long-terM OUtcomes after the Multisystem Inflammatory Syndrome In Children (MUSIC): Design and Objectives. Am. heart j., 243, 43-53.
Vari, D., Miller, J. M., Rellosa, N., Srivastava, S., Frizzola, M., & Thacker, D. (2020). Severe cardiac dysfunction in a patient with multisystem inflammatory syndrome in children associated with COVID-19: Retrospective diagnosis of a puzzling presentation. A case report. PPC, 58, 101270.
Vogel, T. P., Top, K. A., Karatzios, C., Hilmers, D. C., Tapia, L. I., Moceri, P., & Munoz, F. M. (2021). Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine, 39(22), 3037-3049.
Wu, E. Y., & Campbell, M. J. (2021). Cardiac Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19. Current Science, 23(11), 1-9.
Zhou, C., Zhao, Y., Wang, X., Huang, Y., Tang, X., & Tang, L. (2021). Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease. Pediatric Pulmonology, 56(12), 3688-3698.
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Copyright (c) 2022 Trinnye Luizze Santos; Caroline Silva de Araujo Lima; Camila Melo de Freitas; Alice Deberaldini Marinho; Walquiria da Silva Pedra Parreira; Bruna Katharine Cavalcante Nascimento ; Aline Silva Lima; José Tálison Vieira; Arthur Dias Borges ; Tainá Rodrigues Toqueton; Lucas Lima Moreira; Márcia Farsura de Oliveira
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