Giant coronary artery aneurysm as a feature of coronavirus-related inflammatory syndrome

Richardson, Kerrie Louise; Jain, Ankita; Evans, Jennifer; Uzun, Orhan

doi:10.1136/bcr-2020-238740

Cited by 13 publications

(12 citation statements)

References 9 publications

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“…From the full‐text reading, 29 more studies were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, 8–57 and 30 were included in the meta‐analysis (Figure 1). 8–37 …”

Section: Resultsmentioning

confidence: 99%

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Arantes

Conegundes

Miranda

et al. 2023

Reviews in Medical Virology

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According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS‐COV‐2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS‐C, representing more than 2 million children worldwide. This systematic review and meta‐analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS‐C. The PROSPERO register number is CRD42022327212. We included case‐report studies, case‐control studies, cohort studies, and cross‐sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS‐C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta‐analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%–44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%–51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%–23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%–19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%–12.3%), and the mortality rate was 0.5% (CI 95%: 0%–1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long‐lasting manifestations of 9.3% (95% CI: 5.6%–13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning.

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Section: Resultsmentioning

confidence: 99%

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Arantes

Conegundes

Miranda

et al. 2023

Reviews in Medical Virology

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“…Clearly, the blockage of a blood vessel by a microclot is likely to exert pressure on the vessel's walls, potentially weakening it, and so it is reasonable that aneurysms might be expected to accompany diseases involving microclots. This turns out to be the case in rheumatoid arthritis [ 490 ], acute COVID [ 491 , 492 ] (which bears similarities to Kawasaki disease [ 493 ]) and Long COVID [ 17 ]. The association with ME/chronic fatigue syndrome is seemingly weaker, and is usually seen as an association of fatigue, for example, driven by a subarachnoid haemorrhage [ 494 , 495 ].…”

Section: Aneurysmsmentioning

confidence: 99%

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Kell

2022

Biochemical Journal

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Ischaemia–reperfusion (I–R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I–R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.

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“…MIS-C responds rapidly to steroids and inotropic agents, leading to the complete resolution of clinical symptoms without the need for IVIG. Nonetheless, giant coronary artery aneurysms rarely occur in the course of COVID-19 antibody positive infants even after IVIG administration [13], [14]. MIS-C-related shock commonly occurs with significantly elevated inflammatory markers, low platelet count, but without hypoalbuminemia, no peripheral extremity or mucosal changes, absent lymphadenopathy, and no evidence of sterile pyuria or thrombocytosis.…”

Section: Discussionmentioning

confidence: 99%

Association of Kawasaki Disease Shock Syndrome with Giant Coronary Artery Dilatation – Presentation of Two Cases and A Literature Review

Bejiqi

Retkoceri

et al. 2022

Open Access Maced J Med Sci

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Introduction Kawasaki disease is an acute, self-limited vasculitis of childhood characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15 to 25% of untreated children with the disease and may lead to myocardial infarction, sudden death, or ischemic heart disease. Despite an overlap of clinical features with toxic shock syndrome, children with Kawasaki disease generally do not develop chock. Cases Here we report two old children who presented with a toxic shock-like illness, and were diagnosed with Kawasaki disease when coronary artery abnormalities were found on transthoracic echocardiography, recently reported as a “Kawasaki disease shock syndrome”. Relevant articles about KD and shock were collected and demographic data, clinical presentation, laboratory variables, echocardiogram findings, treatment and special features were analyzed when available. Conclusion Pediatrics cardiologist should be aware of this potentially severe form of manifestation of the Kawasaki disease. Key words Kawasaki disease, Kawasaki disease shock syndrome, coronary artery aneurysm, intravenous immunoglobulin,

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Giant coronary artery aneurysm as a feature of coronavirus-related inflammatory syndrome

Cited by 13 publications

References 9 publications

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS‐C) associated with SARS‐CoV‐2 infection: Systematic review and meta‐analysis

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Association of Kawasaki Disease Shock Syndrome with Giant Coronary Artery Dilatation – Presentation of Two Cases and A Literature Review

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