How safe are children with COVID-19 from cardiac risks? Pediatric risk assesment; insights from echocardiography and electrocardiography

How safe are children with COVID-19 from cardiac risks? Pediatric risk assesment; insights from echocardiography and electrocardiography

Background/aim: Approximately 40 million individuals worldwide have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). Despite the current literature about the cardiac effects of COVID-19 in children, more information is required. We aimed to determine both cardiovascular and arrhythmia assessment via electrocardiographic and echocardiographic parameters. Materials and methods: We evaluated seventy children who were hospitalized with COVID-19 infections and seventy children as normal control group through laboratory findings, electrocardiography (ECG), and transthoracic echocardiography (TTE). Results: We observed significantly increased levels of Tp-Te, Tp-Te/QT, and Tp-Te/QTc compared with the control group. Twenty-five of 70 (35.7%) patients had fragmented QRS (fQRS) without increased troponin levels. On the other hand, none of the patients had pathologic corrected QT(QTc) prolongation during the illness or its treatment. On TTE, 20 patients had mild mitral insufficiency, among whom only five had systolic dysfunction (ejection fraction < 55%). There was no significant difference between the patient and control groups, except for isovolumic relaxation time (IVRT) in terms of mean systolic and diastolic function parameters. IVRT of COVID patients was significantly lower than that of control group. Conclusion: Despite all the adult studies, the effects of COVID‐19 on myocardial function are not well established in children. The thought that children are less affected by the illness may be a misconception.Key words: Children, COVID-19, electrocardiography, risk

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  • 1. NA Zhu, Dingyu Zhang, Wenling Wang, Xingvang Li, Bo Yang et al. A novel coronavirus from patients with pneumonia in China, 2019. The New England Journal of Medicine 2020; 382: 727‐733. doi: 10.1056/NEJMoa2001017
  • 2. Lee N, Hui D, Wu A, Chan P, Cameron P et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. The New England Journal of Medicine 2003; 348: 1986‐1994. doi: 10.1056/NEJMoa030685
  • 3. Booth CM, Matukas LM, Tomlinson GA, Rachilis AR, Rose DB et al. Clinical features and short‐term outcomes of 144 patients with SARS in the greater Toronto area. The Journal of American Medical Association 2003; 289: 2801‐2809. doi: 10.1001/jama.289.21.JOC30885
  • 4. Li SS, Cheng C, Fu C, Chan YH, Lee MP et al. Left ventricular performance in patients with severe acute respiratory syndrome: a 30‐day echocardiographic follow‐up study. Circulation 2003; 108: 1798‐1803. doi: 10.1161/01.CIR.0000094737.21775.32
  • 5. Vandenberk B, Robyns T, Goovaerts G, Claeys M, Helsen F et al. Inter- and intra-observer variability of visual fragmented QRS scoring in ischemic and non-ischemic cardiomyopathy. The Journal of Electrocardiology 2018; 51 (3): 549-554. doi: 10.1016/j.jelectrocard.2017.12.002
  • 6. Tahir F, Bin Arif T, Ahmed J, Malik F, Khalid M. Cardiac manifestations of coronavirus disease 2019 (COVID-19): a comprehensive review. Cureus 202; 12 (5): e8021. doi:10.7759/ cureus.8021
  • 7. Sanna G, Serrau G, Bassareo PP, Neroni P, Fanos V. Children’s heart and COVID-19: up-to-date evidence in the form of a systematic review. European Journal of Pediatrics. 2020; 179 (7): 1079-1087. doi: 10.1007/s00431-020-03699-0
  • 8. Cozzi D, Albanesi M, Cavigli E, Moroni C, Bindi A et al. Chest X-ray in new Coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome. La Radiologia Medica 2020; 9: 1-8. doi: 10.1007/s11547-020-01232-9
  • 9. Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. The Journal of Electrocardiology 2011; 44: 301-308. doi: 10.1016/j. jelectrocard.2011.03.004
  • 10. Supreeth RN, Francis J. Fragmented QRS - its significance. Indian Pacing and Electrophysiology Journal 2020; 20 (1): 27- 32. doi: 10.1016/j.ipej.2019
  • 11. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF et al. Diagnosis, treatment, and long term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135 (17): 927-999. doi: 10.1161/CIR.0000000000000484
  • 12. Teicholz LE, Kreulein T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographicangiographic correlations in the presence of absence of asynergy. American Journal of Cardiology 1976; 37 (1): 7-11.
  • 13. Dong Y, Mo X, Hu Y, Qi X, Jiang F et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; e20200702. doi: 10.1542/ peds.2020-0702
  • 14. Xiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long‐term implications. European Heart Journal 2020; 41 (19): 1798- 1800. doi: org/10.1093/eurheartj/ehaa231
  • 15. Yu CM, Wong RS, Wu EB, Kong SL, Wong J et al. Cardiovascular complications of severe acute respiratory syndrome. Postgraduate Medical Journal 2006; 82: 140‐144. doi: 10.1136/ pgmj.2005.037515
  • 16. Ece İ, Koçoğlu M, Kavurt AV, Bağrul D, Gül AEK et al. Assessment of cardiac arrhythmic risk in children with Covid-19 infection. Pediatric Cardiology 2020; 2: 1-5. doi: 10.1007/s00246-020-02474-0
  • 17. Wang D, Hu B, Hu C, Zhu F, Liu X et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in wuhan, China. The Journal of American Medical Association 2020; 323 (11): 1061-1069 doi:10.1001/jama.2020.1585
  • 18. Lazzerini PE, Boutjdir MB, Capecchi PL. COVID-19, arrhythmic risk andinflammation: mind the gap! Circulation 2020; 142: 7-9. doi: 10.1161/ CIRCULATIONAHA.120.047293
  • 19. Chen Y, Guo X, Sun G, L. Zhao, Zheng L et al. Effect of serum electrolytes within normal ranges on QTc prolongation: a cross-sectional study in a Chinese rural general population. BMC Cardiovascular Disorders 2018; 18: 175. doi:10.1186/ s12872-018-0906-1
  • 20. Clark RE, Christlieb I, Sanmarco M, Diaz-Perez R, Dammann JF. Relationship of hypoxia to arrhythmia and cardiac conduction hemorrhage: an experimental study. Circulation 1963; 27: 742-747. doi: 10.1161/01.CIR.27.4.742
  • 21. Rattanawong P, Vutthikraivit W, Charoensri A, Jongraksak T, Prombandankul A et al. Fever induced Brugada syndrome is more common than previously suspected: a cross-sectional study from an endemic area. Journal of American College of Cardiology 2015; 65 (10 Supp): A430. doi: 10.1111/anec.12288
  • 22. Schwartz PJ, Crotti L, Insolia R. Long-QT syndrome: from genetics to management. Circulation: Arrhythmia and Electrophysiology 2012; 5: 868-877. doi: 10.1161/ CIRCEP.111.962019
  • 23. Jain R, Singh R, Yamini S, Das MK. Fragmented ECG as a risk marker in cardiovascular diseases. Current Cardiology Reviews 2014; 10 (3): 277-286. doi: 10.2174/1573403x10666140514103451
  • 24. Eyuboglu M, Kucuk U, Senarslan O, Akdeniz B. Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity. Revista Portuguesa de Cardiologia 2017; 36 (2): 89-93. doi: 10.1016/j.repc.2016.07.008
  • 25. Xu S, Yang L, Hong D, Chen L, Wang X. Predictive value of fragmented QRS for ventricular tachyarrhythmias in patients with acute myocardial infarction: a meta-analysis. European Journal of Clinical Investigation 2020; 50 (2): e13182. doi: 10.1111/eci.13182
  • 26. Zhao Q, Zhang R, Hou J, Yu B. Relationship between fragmented QRS and NTproBNP in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Acta Cardiologica Sinica 2018; 34 (1): 13-22. doi:10.6515/ACS.201801_34(1).20170903A
  • 27. Meng L, Letsas KP, Baranchuk A, Shao Q, Tse G et al. Metaanalysis of fragmented QRS as an electrocardiographic predictor for arrhythmic events in patients with Brugada syndrome. Frontiers in Physiology 2017; 8: 678. doi: 10.3389/ fphys.2017.00678
  • 28. Tschabrunn CM, Haqqani HM, Santangeli P, Zado ES, Marchlinski FE. 12-Lead electrocardiogram to localize region of abnormal electroanatomic substrate in arrhythmogenic right ventricular cardiomyopathy. Journal of the American College of Cardiology: Clinical Electrophysiology 2017; 3 (7): 654-665. doi: 10.1016/j.jacep.2017.01.009
  • 29. Samuel S, Friedman RA, Sharma C, Ganigara M, Mitchell E et al. Incidence of arrhythmias and electrocardiographıc abnormalities in symptomatic pediatric patients with pcr positive sars-cov-2 infection including drug induced changes in the corrected qt ınterval (qtc). Heart Rhythm 2020; 17 (11): 1960-1966. doi: 10.1016/j.hrthm.2020.06.033
  • 30. Ho JS, Sia CH, Chan MY, Lin W, Wong RC. Coronavirusinduced myocarditis: a meta summary of cases. Heart Lung 2020; 49 (6): 681-685. doi: 10.1016/j.hrtlng.2020.08.013
  • 31. De Bruyne MC, Hoes AW, Kors JA, Hofman A, Van Bemmel JH et al. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam study. Circulation 1998; 97 (5): 467-472. doi: 10.1161/01.cir.97.5.467
  • 32. Kors JA, Van Herpen G, Van Bemmel JH. QT dispersion as an attribute of T-loop morphology. Circulation 1999; 99 (11): 1458-1463. doi: 10.1161/01.cir.99.11.1458
  • 33. Kors JA, Ritsema Van Eck HJ, Van Herpen G. The meaning of the Tp-Te interval and its diagnostic value. Journal of Electrocardiology 2008; 41 (6), 575-580. doi: 10.1016/j. jelectrocard.2008.07.030
  • 34. Demidova MM, Carlson J, Erlinge D, Azarov JE, Platonov PG. Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction. International Journal of Cardiology 2019; 280: 80- 83. doi: 10.1016/j.ijcard.2019.01.008
  • 35. Zhao X, Xie Z, Chu Y, Yang L, Xu W et al. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clinical Cardiology 2012; 35 (9): 559- 564. doi: 10.1002/clc.22022
  • 36. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B et al. T(p-e)/QT ratio as an index of arrhythmogenesis. Journal of Electrocardiology 2008; 41 (6): 567-574. doi: 10.1016/j. jelectrocard.2008.07.016
  • 37. Yayla Ç, Özcan F, Aras D, Turak O, Özeke Ö et al. Tp-e interval and Tp-e/QT ratio before and after catheter ablation in patients with premature ventricular complexes. Biomarkers in medicine 2017; 11 (4): 339-346. doi: 10.2217/bmm-2016-0263
  • 38. Ucar FM, Ozturk C, Yılmaztepe MA. Evaluation of Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with acute Myocarditis. BMC Cardiovascular Disorders 2019; 19 (1): 232. doi: 10.1186/s12872-019-1207-z
  • 39. Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Annals of the Rheumatic Diseases 2020; 0: 1-8. doi:10.1136/ annrheumdis-2020-21796
  • 40. Gonzalez MR, Martinez AC, Poyatos HMC, Reviriego AAP. Cardiovascular impact of COVID-19 with a focus on children: a systematic review. World Journal of Clinical Cases 2020; 8 (21): 5250-5283. doi: 10.12998/wjcc.v8.i21.5250
  • 41. Loomba RS, Villarreal EG, Flores S. COVID-19 and hyperinflammatory syndrome in children: Kawasaki disease with macrophage activation syndrome in disguise? Cureus 2020; 12 (8): e9515. doi: 10.7759/cureus.951
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