Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19

Fremed, Michael; Healy, Emma; Choi, Nak Hyun; Cheung, Eva W.; Choudhury, Tarif; Jiang, Pengfei; Liberman, Leonardo; Zucker, Jason; Lytrivi, Irene D.; Starc, Thomas J.

doi:10.1017/s1047951122000397

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…While our study identified a cardiac abnormality in close to half of the tested patients, we identified an elevated troponin in 18% of patients. This is in contrast to other studies reporting an incidence of elevated troponin to be closer to 1% of patients [ 1 , 5 ]. Selection bias may account for a portion of this discrepancy, as not every admitted patient underwent cardiac testing.…”

Section: Discussioncontrasting

confidence: 97%

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Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19

Pasternack¹,

Singh²,

Minocha³

et al. 2023

Cureus

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Introduction Coronavirus disease 2019 (COVID-19) is known to cause cardiac abnormalities in adults. Cardiac abnormalities are well-described in multisystem inflammatory syndrome in children, but effects in children with acute COVID-19 are less understood. In this multicenter study, we assessed the cardiac effects of acute COVID-19 among hospitalized children (<21 years) admitted to three large healthcare systems in New York City. Methods We performed a retrospective observational study. We examined electrocardiograms, echocardiograms, troponin, or B-type natriuretic peptides. Results Of 317 admitted patients, 131 (41%) underwent cardiac testing with 56 (43%) demonstrating cardiac abnormalities. Electrocardiogram abnormalities were the most common (46/117 patients (39%)), including repolarization abnormalities and QT prolongation. Elevated troponin occurred in 14/77 (18%) patients and B-type natriuretic peptide in 8/39 (21%) patients. Ventricular dysfunction was identified in 5/27 (19%) patients with an echocardiogram, all of whom had elevated troponin. Ventricular dysfunction resolved by first outpatient follow-up. Conclusion Electrocardiogram and troponin can assist clinicians in identifying children at risk for cardiac injury in acute COVID-19.

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Section: Discussioncontrasting

confidence: 97%

“…Children with COVID-19 generally have favorable outcomes compared to adults, although this is not always the case and some children experience severe disease occasionally resulting in death [ 1 , 9 ]. Cardiac changes occur in up to 20% of pediatric patients [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19

Pasternack¹,

Singh²,

Minocha³

et al. 2023

Cureus

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“…Cardiac involvement associated with MIS-C has been commonly reported, but the characteristics of cardiac involvement in children with SARS-CoV-2 infection have not been well described. Fremed et al [ 25 ] evaluated 80 pediatric patients and excluded MIS-C and chronic heart disease patients, like our study. They reported that high-sensitivity troponin T and/or NT-proBNP were measured in 34% of patients, and abnormalities were present in 19%, all of whom had underlying comorbidities.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

et al. 2022

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Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2–max. 144) months, which was statistically lower than the age of patients with normal troponin levels ( P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay ( P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels ( P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.

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“…Prior studies reported findings of elevated troponin and B-type natriuretic peptide (BNP) for pediatric patients hospitalized during acute COVID-19 infection. 8 Electrocardiogram (ECG) findings of prolonged QTc, nonspecific Twave abnormalities, and ST segment elevation and depression have also been reported. 8 However, cardiac dysfunction during acute COVID-19 infection in the pediatric population has not been well-described.…”

Section: Covid-19 Infection and Multisystem Inflammatory Syndrome In ...mentioning

confidence: 99%

“…8 Electrocardiogram (ECG) findings of prolonged QTc, nonspecific Twave abnormalities, and ST segment elevation and depression have also been reported. 8 However, cardiac dysfunction during acute COVID-19 infection in the pediatric population has not been well-described. There are small case series reporting myocarditis, pericarditis, arrhythmias, and cardiogenic shock in adolescents (►Table 1).…”

Section: Covid-19 Infection and Multisystem Inflammatory Syndrome In ...mentioning

confidence: 99%

Cardiac Effects of COVID-19 Infection, MIS-C, and the Vaccine in Infants and Children: What Is Known and Future Implications

et al. 2022

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The cardiac effects of novel coronavirus disease 2019 (COVID-19) infection on the pediatric heart has become an area of particular interest as elevated cardiac enzymes and abnormalities on echocardiogram and electrocardiogram were seen in a portion of children affected by the virus. In this article, we review the cardiac manifestations of acute COVID-19 infection, multisystem inflammatory syndrome in children, and postvaccine myocarditis. The limited research on the effects of COVID-19 on neonates and infants is also reported. Key Points

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Elevated cardiac biomarkers and outcomes in children and adolescents with acute COVID-19

Cited by 5 publications

References 21 publications

Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19

Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience

Cardiac Effects of COVID-19 Infection, MIS-C, and the Vaccine in Infants and Children: What Is Known and Future Implications

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