Short-term Cardiovascular Complications of Multi-system Inflammatory Syndrome in Children (MIS-C) in Adolescents and Children

Abstract Background Multi-inflammatory syndrome in children (MIS-C) is a novel and rare inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school-age children. Reports in the past year have suggested a multi-system pathophysiology characterized by hyperinflammation, gastrointestinal distress, and cardiovascular complications. Clinical laboratory investigations, including routine blood testing for inflammatory (e.g., CRP, ferritin) and cardiac (e.g., troponin, brain natriuretic peptides) markers have provided insight into potential drivers of disease pathogenesis, highlighting the role of the laboratory in the differential diagnosis of patients presenting with similar conditions (e.g., Kawasaki Disease, Macrophage Activating Syndrome). Content While few studies have applied high-dimensional immune profiling to further characterize underlying MIS-C pathophysiology, much remains unknown regarding predisposing risk factors, etiology, and long-term impact of disease onset. The extent of autoimmune involvement is also unclear. In the current review, we summarize and critically evaluate available literature on potential pathogenic mechanisms underlying MIS-C onset and discuss the current and anticipated value of various laboratory testing paradigms in MIS-C diagnosis and monitoring. Summary From initial reports, it is clear that MIS-C has unique inflammatory signatures involving both adaptive and innate systems. Certain cytokines, inflammatory markers, and cardiac markers assist in the differentiation of MIS-C from other hyperinflammatory conditions. However, there are still major gaps in our understanding of MIS-C pathogenesis, including T cell, B cell, and innate response. It is essential that researchers not only continue to decipher initial pathogenesis but also monitor long-term health outcomes, particularly given observed presence of circulating autoantibodies with unknown impact.

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S83. MORTALITY, REVASCULARIZATION AND CARDIOPROTECTIVE PHARMACOTHERAPY AFTER ACUTE CORONARY SYNDROME IN PATIENTS WITH PSYCHOTIC DISORDERS: A POPULATION-BASED COHORT STUDY

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.149 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S65-S66 ◽

Cited By ~ 1

Author(s):

Wing Chung Chang ◽

Joe Kwun Nam Chan ◽

Corine Sau Man Wong ◽

Philip Chi Fai Or ◽

JoJo Siu Han Hai

Keyword(s):

Acute Coronary Syndrome ◽

Cohort Study ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Cardiovascular Complications ◽

Population Based ◽

Public Healthcare ◽

Complication Rates ◽

Short Term ◽

Coronary Syndrome

Abstract Background Ischemic heart disease is the leading cause of premature mortality in psychotic disorders. The authors aimed to examine short-term mortality, cardiovascular complications, revascularization and cardioprotective medication receipt after incident acute coronary syndrome (ACS) among patients with psychotic disorders compared with patients without psychotic disorders. Methods This was a population-based cohort study with data retrieved from a territory-wide medical record database of public healthcare services to 7.5 million residents in Hong Kong. The study identified 67,692 patients aged ≥18 years admitted for first-recorded ACS between January 1, 2006 and December 31, 2016. The cohort was dichotomously divided by pre-ACS diagnosis of psychotic disorder. Multivariate regression (adjusted odds ratio [aOR] and 95%CI) was used to examine associations of psychotic disorders with all-cause 30-day and 1-year mortality, cardiovascular complications, 30-day and 1-year invasive cardiac procedures, and 90-day post-discharge cardioprotective medication prescription. Results Patients with psychotic disorders (N=703) had higher 30-day (aOR=1.99, 95%CI=1.65–2.39) and 1-year (aOR=2.13, 95%CI=1.79–2.54) mortality, and cardiovascular complication rates (aOR=1.20, 95%CI=1.02–1.41), lower receipt of cardiac catheterization (30-day: aOR=0.54, 95%CI=0.43–0.68; 1-year: aOR=0.46, 95%CI=0.38–0.56), percutaneous coronary intervention (30-day: aOR=0.55, 95%CI=0.44–0.70; 1-year: aOR=0.52, 95%CI=0.42–0.63) and reduced β-blockers (aOR=0.81, 95%CI=0.68–0.97), statins (aOR=0.54, 95%CI=0.44–0.66), and clopidogrel prescriptions (aOR=0.66, 95%CI=0.55–0.80). Effect of psychotic disorder on heightened mortality was more pronounced in younger-aged (<65 years) and male patients. Associations between psychotic disorder and increased mortality remained significant even after complications and treatment receipt were additionally adjusted. Discussion Psychotic disorders are associated with increased risks of short-term post-ACS mortality, cardiovascular complications and inferior treatment. Excess mortality is not substantially explained by treatment inequality. Further investigation is warranted to clarify factors for suboptimal cardiac-care and elevated mortality in psychotic disorders to enhance post-ACS outcome.

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Multisystem inflammatory syndrome in adults (MIS-A) associated with SARS-CoV-2 infection with delayed-onset myocarditis: case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab470 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Miles Shen ◽

Aidan Milner ◽

Carlo Foppiano Palacios ◽

Tariq Ahmad

Keyword(s):

Cardiovascular Complications ◽

Clinical Syndrome ◽

Resonance Imaging ◽

Non Invasive ◽

Respiratory Involvement ◽

Case Summary ◽

Organ Systems ◽

Magnetic Resonance Imaging Mri ◽

Inflammatory Syndrome ◽

Supportive Management

Abstract Background During the Coronavirus disease 2019 (COVID-19) pandemic, reports have emerged of a multisystem inflammatory syndrome in adults (MIS-A). Multisystem inflammatory syndrome in adults can affect various organ systems, including cardiovascular, gastrointestinal, and neurologic systems without significant respiratory involvement. Case summary A previously healthy 43-year-old man presented with fevers and abdominal pain then rapidly deteriorated into cardiogenic shock. His constellation of symptoms along with elevated inflammatory markers in the setting of a recent SARS-CoV-2 infection was consistent with the diagnosis of MIS-A. He also had a comprehensive infectious workup that was unremarkable, ruling out other potential infectious aetiologies for his presentation. He subsequently improved through supportive measures and after administration of intravenous immunoglobulin (IVIG). He later demonstrated recovery of cardiac function and cardiac magnetic resonance imaging (MRI) showed signs consistent with myocarditis. Discussion As the COVID-19 pandemic continues to be an ongoing issue, it is important to recognize MIS-A, a rare and potentially deadly clinical syndrome that can lead to profound cardiovascular complications. Non-invasive imaging modalities such as cardiac MRI can play a role in the identification of myocarditis. In addition to supportive management, adjunctive therapies such as IVIG may be efficacious in MIS-A and should be further investigated.

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Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

European Heart Journal ◽

10.1093/eurheartj/ehab724.0412 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

K Gonzalez ◽

I Mendoza Britto ◽

M Mateu ◽

E Marcano ◽

J De Izaguirre ◽

...

Keyword(s):

Clinical Laboratory ◽

Sinus Bradycardia ◽

Case Series ◽

Intravenous Immunoglobulins ◽

Cardiovascular Complications ◽

Laboratory Evaluation ◽

Initial Manifestation ◽

Funding Sources ◽

Coronary Abnormalities ◽

Inflammatory Syndrome

Abstract Background While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C. Methods We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan. Results Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted. Treatment All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins. Conclusion Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation. FUNDunding Acknowledgement Type of funding sources: None. Kid, MIS-C. Bradycardia/Atrial Rhythm

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Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe

Circulation ◽

10.1161/circulationaha.120.050065 ◽

2021 ◽

Vol 143 (1) ◽

pp. 21-32 ◽

Cited By ~ 1

Author(s):

Israel Valverde ◽

Yogen Singh ◽

Joan Sanchez-de-Toledo ◽

Paraskevi Theocharis ◽

Ashish Chikermane ◽

...

Keyword(s):

Intensive Care ◽

Natriuretic Peptide ◽

Cardiac Imaging ◽

Immunoglobulin G ◽

Cardiac Troponin ◽

Cardiovascular Complications ◽

C Reactive Protein ◽

Reactive Protein ◽

Inflammatory Syndrome ◽

Care Support

Background: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. Methods: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. Results: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8–12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support ( P <0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. Conclusions: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.

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Assessment of Short-term, Within Hospital Cardiovascular Complications After Renal Transplantation in Baqiyatallah Hospital

Materia Socio Medica ◽

10.5455/msm.2019.31.241-245 ◽

2019 ◽

Vol 31 (4) ◽

pp. 241

Author(s):

Mohsen Ghahrodi ◽

Behzad Einollahi ◽

Amir Baharvand ◽

Mohammad Javanbakht

Keyword(s):

Renal Transplantation ◽

Cardiovascular Complications ◽

Short Term

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A Survey on Cardiac Complications of COVID-19 in Infants

World Journal of Peri & Neonatology ◽

10.18502/wjpn.v4i1.7544 ◽

2021 ◽

Author(s):

Reza Bahrami ◽

Sedigheh Ekraminasab ◽

Fatemeh Asadian

Keyword(s):

Cardiac Involvement ◽

Scientific Evidence ◽

Fatal Outcome ◽

Cardiovascular Complications ◽

Cardiac Complications ◽

Limited Data ◽

Predisposing Factor ◽

Young Subjects ◽

Inflammatory Syndrome ◽

Underlying Pathophysiology

Congenital heart disease (CHD) may have serious effects on the course of COVID-19. Limited data were available on CHD in neonates with COVID-19. This study aimed to review the cardiac complications in neonates infected with COVID-19. Some studies showed that myocardial injury in adult patients is often correlated with a fatal outcome. But, scientific evidence in infants is rare, although several reports were published with the description of cardiac involvement in COVID-19 pediatric patients. In these young subjects, a background of surgically treated CHD seems to be a predisposing factor. Numerous studies showed Multisystem inflammatory syndrome in children (MIS-c) is a deadly demonstration of COVID-19 with cardiac involvement. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of the myocardium, systemic inflammatory response, coagulation abnormalities and thrombosis and hypoxia have been suggested as possible mechanisms of cardiac complications. It seems COVID-19 can affect different parts of the heart; however, the myocardium is more involved. The mechanisms of pathogenesis of cardiovascular implications in adults and infants are similar but CHD and MIS-c in infants are more important. Further studies on the effects of COVID-19 on the neonatal cardiovascular system are needed.

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Short-Term Outcomes After Multisystem Inflammatory Syndrome in Children Treatment

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa151 ◽

2020 ◽

Author(s):

Katharine N Clouser ◽

Jasmine Gadhavi ◽

Sejal M Bhavsar ◽

Rachel Lewis ◽

Cathleen Ballance ◽

...

Keyword(s):

Chart Review ◽

Clinical Status ◽

Treatment Algorithm ◽

Retrospective Chart Review ◽

Clinical Spectrum ◽

Short Term ◽

Inflammatory Syndrome

Abstract This is a retrospective chart review of 20 patients treated with a consensus-driven treatment algorithm in multisystem inflammatory syndrome in children patients across a wide clinical spectrum. Their treatments and clinical status are described as well as their favorable return to functional baseline by 30 days post presentation.

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Insulin Resistance and Homocysteine Levels in Patients with Polycystic Ovarian Syndrome

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1222 ◽

2013 ◽

Vol 5 (2) ◽

pp. 49-51

Author(s):

Suresh Chari ◽

Sunita Ghike ◽

Madhur Mahesh Gupta ◽

Manju Chandankhede

Keyword(s):

Insulin Resistance ◽

Lipid Profile ◽

Polycystic Ovarian Syndrome ◽

Case Control Study ◽

Cardiovascular Complications ◽

Healthy Controls ◽

Short Term ◽

Ovarian Syndrome ◽

Control Study

ABSTRACT Objectives To assess association in between insulin resistance and homocysteine levels in patients with polycystic ovarian syndrome (PCOS). Methods A case control study. Setting Hospital based. Patients Forty females diagnosed with PCOS were matched with 40 normal healthy controls. Intervention Blood samples for insulin, lipid profile, fasting glucose and homocysteine measurements. Results Our study suggests that PCOS patients have insulin resistance, dyslipidemia and hyperhomocysteinemia when compared with normal healthy controls. Conclusion To determine the short-term implications of reproductive performance and long-term implications regarding cardiovascular complications associated with PCOS the assessment of insulin resistance, lipid profile along with homocysteine levels in patients of PCOS is warranted. How to cite this article Gupta MM, Chari S, Chandankhede M, Ghike S. Insulin Resistance and Homocysteine Levels in Patients with Polycystic Ovarian Syndrome. J South Asian Feder Obst Gynae 2013;5(2):49-51.

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