Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital
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- 12 June 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Pediatric Cardiology
- Vol. 41 (7), 1391-1401
- https://doi.org/10.1007/s00246-020-02391-2
Abstract
Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome—“Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2” (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children’s hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4–11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.Keywords
This publication has 21 references indexed in Scilit:
- Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in ChinaJAMA, 2020
- Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015Archives of Disease in Childhood, 2018
- Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and EthnicityCirculation: Cardiovascular Imaging, 2017
- Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart AssociationCell Metabolism, 2017
- Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular ImagingEuropean Heart Journal – Cardiovascular Imaging, 2015
- Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular ImagingJournal of the American Society of Echocardiography, 2015
- Toxic Shock SyndromeCritical Care Clinics, 2013
- Left ventricular long-axis function: Reference values of the mitral annular plane systolic excursion in 558 healthy children and calculation of z-score valuesAmerican Heart Journal, 2012
- Right Ventricular Function in Infants, Children and Adolescents: Reference Values of the Tricuspid Annular Plane Systolic Excursion (TAPSE) in 640 Healthy Patients and Calculation of z Score ValuesJournal of the American Society of Echocardiography, 2009
- Impact of cardiac growth on doppler tissue imaging velocities: a study in healthy childrenJournal of the American Society of Echocardiography, 2004