Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19

Abstract

Background: Although most children may experience mild to moderate symptoms and do not require hospitalization, there are little data on cardiac involvement in COVID-19. However, cardiac involvement is accurately demonstrated in children with MISC. The objective of this study was to evaluate cardiac mechanics in previously healthy children who recovered from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a long-term follow-up by means of two-dimensional speckle-tracking echocardiography (STE). Methods: We analyzed a cohort of 157 paediatric patients, mean age 7.7 ± 4.5 years (age range 0.3–18 years), who had a laboratory-confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent a standard transthoracic echocardiogram and STE at an average time of 148 ± 68 days after diagnosis and were divided in three follow-up groups (<180 days, 180–240 days, >240 days). Patients were compared with 107 (41 females—38%) age- and BSA-comparable healthy controls (CTRL). Results: Left ventricular (LV) global longitudinal strain (post-COVID-19: −20.5 ± 2.9 %; CTRL: −21.8 ± 1.7 %; p < 0.001) was significantly reduced in cases compared with CTRLs. No significant differences were seen among the three follow-up groups (p = NS). Moreover, regional longitudinal strain was significantly reduced in LV apical-wall segments of children with disease onset during the second wave of the COVID-19 pandemic compared to the first wave (second wave: −20.2 ± 2.6%; first wave: −21.2 ± 3.4 %; p = 0.048). Finally, peak left atrial systolic strain was within the normal range in the post-COVID-19 group with no significant differences compared to CTRLs. Conclusions: Our study demonstrated for the first time the persistence of LV myocardial deformation abnormalities in previously healthy children with an asymptomatic or mildly symptomatic (WHO stages 0 or 1) COVID-19 course after an average follow-up of 148 ± 68 days. A more significant involvement was found in children affected during the second wave. These findings imply that subclinical LV dysfunction may also be a typical characteristic of COVID-19 infection in children and are concerning given the predictive value of LV longitudinal strain in the general population.

Cardiac Function Evaluation after SARS-CoV-2 mRNA Vaccination in Children and Adolescents: A Prospective Speckle-Tracking Echocardiography Study

“…On the other hand, the results regarding the impairment of myocardial longitudinal strain after SARS-CoV2 infection were in line with previously published data [ 19 , 21 , 38 ] on both children and adult patients with an asymptomatic or mildly symptomatic COVID-19 course, demonstrating a slight but significant reduction in cardiac longitudinal deformation in children with a previous SARS-CoV-2 infection compared to those who were only vaccinated.…”

“…The methodology for STE analysis was previously described [ 19 , 21 ]; it was performed by two experienced echocardiographers blind to the clinical data and COVID-19 vaccination status.…”

“…However, since SARS-CoV-2 infects host cells through ACE2 receptors, which are largely expressed in the heart, the infection is supposed to lead to more risk of cardiac involvement than vaccination [ 18 ]. In fact, previous findings demonstrated that also asymptomatic and mild COVID-19 may induce both subclinical myocardial injury with left ventricular deformation in children and adolescents as in adults [ 19 , 20 ] up to 240 days from infection, regardless of the severity of acute disease [ 21 ]. Similarly, other authors described the reduction in global longitudinal strain and left ventricular strain in children with normal left ventricular ejection fraction and without any cardiac symptoms after MIS-C, suggesting a probable subclinical myocardial persistent injury in children after COVID-19 [ 22 , 23 ].…”

Clinical features of COVID-19 in Italian outpatient children and adolescents during Parental, Delta, and Omicron waves: a prospective, observational, cohort study

“…In addition, the long-term clinical impact of infection due to different variants was not assessed. In the same pediatric cohort, we have previously observed that 157 children and adolescents who experienced an asymptomatic or mild COVID-19 during the Parental and Delta waves showed a significant increase in left ventricular myocardial deformation abnormalities compared to 107 age and body surface area-comparable healthy controls −20.5% ± 2.9% vs. −21.8% ± 1.7%; p < 0.001) ( 30 , 31 ). Moreover, we observed that the incidence of left ventricular myocardial deformation abnormalities persisted higher in COVID-19 cases compared to healthy controls up to 148 days after infection ( 30 , 31 ).…”

Advances in researches on long coronavirus disease in children: a narrative review

“…However, in adult studies, sequelae such as myocarditis, chronic heart failure and postural orthostatic tachycardia syndrome have been reported among patients who had recovered from acute infection ( 45 , 46 ), which also suggest the necessity of operating non-invasive examinations in children. In research assessing ventricular function, it was found that children may develop chronic left ventricular deformation and dysfunction, which may be related to chronic inflammation of myocardium ( 47 ). Another study speculated that the changes might be related to the destruction of the myocardial mitochondria ( 48 ).…”