#VisualAbstract: COVID-19 associated with cardiac manifestations in pediatric patients

1. Pediatric patients during the COVID-19 pandemic present with a wide range of cardiac manifestations that require early detection and treatment.

Evidence Rating Level: 2 (Good)

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in increased hyperinflammatory presentations in otherwise healthy children. This international, multi-center, retrospective chart review examined cardiac manifestations in a pediatric cohort with multi-system inflammatory syndrome (MIS-C) occurring during the SARS-CoV2 pandemic. A total of 55 children from five countries met inclusion criteria (M [SD] age = 7.0 [5.2] years). A total of 27 patients (49%) required ICU admission, 35 patients (64%) had evidence of myocardial dysfunction (left ventricular ejection fraction [LVEF] < 60%), 24 patients (44%) had evidence of shock, and 2 patients (4%) did not survive. A total of 11 patients (20% met full criteria for Kawasaki disease and had lower NT pro-BNP (M [SD] = 1,606 [1,089], p = 0.007), ferritin (M [SD] = 171 [57], p = 0.008), and D-dimer (M [SD] = 1.4 [0.7], p = 0.025) levels compared to those not meeting full diagnostic criteria. Patients with full Kawasaki criteria, compared to others, were also younger (M [SD] age = 5.4 [5.7] years, p = 0.01), experienced longer fevers (M [SD] length = 6.3 [1.3] days, p = 0.07), and better LVEF (LVEF 58 [9%], p = 0.05). Overall, this study highlights the spectrum of cardiac manifestations among pediatric patients during the SARS-CoV2 pandemic, allowing for better detection and preparation for treatment in clinical settings.

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