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

Tristan Ramcharan, Oscar Nolan, Chui Yi Lai, Nanda Prabhu, Raghu Krishnamurthy, Alex G Richter, Deepthi Jyothish, Hari Krishnan Kanthimathinathan, Steven B Welch, Scott Hackett, Eslam Al-Abadi, Barnaby R Scholefield, Ashish Chikermane

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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.

Original languageEnglish
Pages (from-to)1391–1401
Number of pages11
JournalPediatric Cardiology
Volume41
Issue number7
Early online date12 Jun 2020
DOIs
Publication statusPublished - Oct 2020

Keywords

  • COVID-19
  • Hyper-inflammatory
  • Kawasaki
  • MIS-C
  • PIMS-TS
  • SARS-CoV-2
  • Mucocutaneous Lymph Node Syndrome/complications
  • Pandemics
  • Ventricular Function, Left
  • Heart Diseases/complications
  • Humans
  • Patient Discharge
  • Hospitals, Pediatric
  • Male
  • Immunoglobulins, Intravenous/therapeutic use
  • Pneumonia, Viral/complications
  • Betacoronavirus
  • Female
  • Retrospective Studies
  • Child
  • Echocardiography
  • Treatment Outcome
  • United Kingdom
  • Stroke Volume
  • Vasoconstrictor Agents/therapeutic use
  • Coronavirus Infections/complications
  • Systemic Inflammatory Response Syndrome/complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

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