Cardiovascular disorders in children who had COVID-19 infection in outpatient settings
DOI:
https://doi.org/10.15574/SP.2024.140.7Keywords:
children, cardiovascular system, COVID-19 infection, heart rhythm disorders, cardiac conduction disordersAbstract
Aim - to study the state of the cardiovascular system (CVS) in children after SARS-CoV-2 infection.
Materials and methods. The study group was completed by 70 children of 7-14 years old without chronic pathology who were asymptomatic, mild or moderate in the course of COVID-19 infection and who had laboratory confirmation of the disease. The comparison group consisted of 30 children aged 7-14 years who had no COVID-19 infection. The state of the CVS was assessed by electrocardiography (ECG) at the rest and after exercise. Structural abnormalities and cardiovascular dysfunction were assessed by echocardiography (EchoCG). Statistical processing of the obtained data was performed with the application package "Statistica 10.0 for Windows" by the method of variation statistics.
Results. Heart rhythm (HR), conductivity and excitability functions disorders were detected in 38.6% (27 children). Heart deterioration of repolarization processes (as the metabolic disorders) was noted in 11.4% (8 children). More than half of the children had a combination of these disorders. The results of the assessment of the CVS response to exercise revealed a hypoergic reaction in 42.8% (30 children) in the form of an increasing of HR in the range of 0-19%, which indicates an insufficient response of the CVS to exercise. In 24.3% (17 children) was noted hyperergic reaction in the form of an increasing heart rate by 40-80%. And only 32.9% (23 children) had a normal reaction of the CVS to physical activity with an increasing heart rate by 20-30%. In the comparison group, the following was noted: normal reaction in 70.0% (21 children), hypoergic type of CVS reaction in 20.0% (6 children) and hyperergic type in 10.0% (3 children).
Conclusions. The COVID-19 infection leads to a deterioration in the CVS response. In the majority of pediatric patients, cardiovascular lesions after SARS-CoV-2 manifest as subclinical changes that are detected during instrumental investigations. The use of non-invasive methods such as ECG and EchoCG help to diagnose cardiovascular lesions, as well as to identify changes in the CVS that may have important prognostic significance for the unfavorable course of the disease in children with SARS-CoV-2 infection. In this regard, it is necessary to introduce mandatory ECG in children before and after exercise testing for early detection of cardiovascular disorders in the practice of pediatricians and general practitioners. If necessary, the use of EchoCG and Holter monitoring of blood pressure and ECG is justified.
The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.
The authors declare no conflict of interest.
References
Ambrosino P, Molino A, Calcaterra I et al. (2021). Clinical assessment of endothelial function in convalescent covid-19 patients undergoing multidisciplinary pulmonary rehabilitation. Biomedicines. 9(6). https://doi.org/10.3390/biomedicines9060614; PMid:34071308 PMCid:PMC8226503
Ciccarelli GP, Bruzzese E, Asile G, Vassallo E, Pierri L, De Lucia V (2021). Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: A case series. Eur. Heart J. Case Rep. 14: ytab405. https://doi.org/10.1093/ehjcr/ytab405; PMid:34993395 PMCid:PMC8728699
Das BB, Akam-Venkata J, Abdulkarim M, Hussain T. (2022). Parametric Mapping Cardiac Magnetic Resonance Imaging for the Diagnosis of Myocarditis in Children in the Era of COVID-19 and MIS-C. Children. 9: 1061. https://doi.org/10.3390/children9071061; PMid:35884045 PMCid:PMC9320921
Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ, Re'em Y et al. (2021). Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 38: 101019. https://doi.org/10.1016/j.eclinm.2021.101019; PMid:34308300 PMCid:PMC8280690
Davis HE, Assaf GS, McCorkell L, Wei H, Low RJ, Re'em Y et al. (2021). Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. 38: 101019. https://doi.org/10.1016/j.eclinm.2021.101019; PMid:34308300 PMCid:PMC8280690
Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H et al. (2021). American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol. 73: e13-e29. https://doi.org/10.1002/art.41616; PMid:33277976 PMCid:PMC8559788
Joshi K, Kaplan D, Bakar A, Jennings JF, Hayes DA, Mahajan S et al. (2020). Cardiac Dysfunction and Shock in Pediatric Patients with COVID-19. JACC Case Rep. 2: 1267-1270. https://doi.org/10.1016/j.jaccas.2020.05.082; PMid:32835268 PMCid:PMC7301074
Kelle S, Bucciarelli-Ducci C, Judd RM, Kwong RY, Simonetti O, Plein S et al. (2020). Society for Cardiovascular Magnetic Resonance (SCMR) recommended CMR protocols for scanning patients with active or convalescent phase COVID-19 infection. J. Cardiovasc. Magn. Reson. 22: 61. https://doi.org/10.1186/s12968-020-00656-6; PMid:32878639 PMCid:PMC7467754
Kvashnina LV, Ihnatova TB. (2015). Profilaktyka porushen endotelialnoi dysfunktsii u ditei u period perekhodu vid zdorovia do syndromu vehetatyvnoi dysfunktsii. Sovremennaya pediatriya. 5(77): 16-24. https://doi.org/10.15574/SP.2016.77.16
Kvashnina LV, Ihnatova TB. (2016). Stan endotelialnoi funktsii u zdorovykh ditei molodshoho shkilnoho viku za danymy biokhimichnoho metodu doslidzhennia. Perynatologiya i pediatriya. 4(68): 86-88. https://doi.org/10.15574/PP.2016.68.86
Kvashnina LV, Ihnatova TB. (2015). Stan endotelialnoi funktsii u zdorovykh ditei molodshoho shkilnoho viku za danymy trypleksnoho ultrazvukovoho doslidzhennia. Sovremennaya pediatriya 8: 54-56.
Kvashnina LV, Maidan IS, Ihnatova TB. (2019). Timely correction of vegetative homeostasis disorders is the prevention of hypertension development among the children. Sovremennaya pediatriya. 1(97):102-110. https://doi.org/10.15574/SP.2019.97.102
Liu PP, Blet A, Smyth D, Li H. (2020). The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation. 142: 68-78. https://doi.org/10.1161/CIRCULATIONAHA.120.047549; PMid:32293910
Mincer OP, Potyazgenko MM, Nevoyt GV. (2022). Korotky zapys variabelnosty rytmu sertca v klinitchnomu obstezgenny pacientiv. Navchalny posibnik. Kiev-Poltava: 151.
NAMN Ukrainy. (2019). Zvit pro NDR Instytutu pediatrii, akusherstva i hinekolohii NAMN Ukrainy. 1: 1-57.
Sagaydachniy АА. (2018, Sep). Reactive hyperemia test: methods of analysis, mechanisms of reaction and prospects. Regional Blood Circulation and Microcirculation. 17(3): 5-22. https://doi.org/10.24884/1682-6655-2018-17-3-5-22
Son MBF, Murray N, Friedman K, Young CC, Newhams MM, Feldstein LR et al. (2021). Multisystem Inflammatory Syndrome in Children-Initial Therapy and Outcomes. N. Engl. J. Med. 385: 23-34. https://doi.org/10.1056/NEJMoa2102605; PMid:34133855 PMCid:PMC8220972
Varga Z, Flammer A, Steiger P et al. (2020). Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 395(2): 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5; PMid:32325026
WHO. (2021). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. (n.d.). World Health Organization. URL: https://www.who.int/publications/i/item/WHO-2019-nCoV/Post_COVID 19_condition-Clinical_case_definition-2021.1
Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. (2021). COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis. Pediatr. Pulmonol. 56: 837-848. https://doi.org/10.1002/ppul.25245; PMid:33428826 PMCid:PMC8013394
Yevtushenko VV, Seriakova IYu, Kramarov SO, Kyrytsia NS, Shadrin VO, Voronov OO. (2023). Kardiovaskuliarni porushennia u ditei z COVID-19. Child's Health. 18(5): 352-361. https://doi.org/10.22141/2224-0551.18.5.2023.1613
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
