Cardiovascular manifestations in pediatric multisystem inflammatory syndrome associated with COVID-19 in a tertiary care pediatric center in Mexico City

Mercy J. Granda-Jiménez, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México
Itzel E. Rios-Olivares, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México
Carlos González-Rebeles-Guerrero, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México
Martha P. Marquez-Aguirre, Servicio de Cuidados Intensivos Pediátricos, Instituto Nacional de Pediatría, Ciudad de México, México
José A. Gutiérrez-Hernández, Servicio de Inmunología Pediátrica. Instituto Nacional de Pediatría, Ciudad de México, México
Laura Camacho-Reyes, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México
Jesús De Rubens-Figueroa, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México
Carlos A. Corona-Villalobos, Servicio de Cardiología Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, México

Objective: The objective is to expose the cardiovascular alterations in patients diagnosed with pediatric inflammatory multisystem syndrome (PIMS) associated with COVID-19 during the SARS-CoV-2 pandemic, in order to understand the disease, its evolution, and optimal management upon diagnosis. Method: Retrospective, observational, cross-sectional analytical study of patients diagnosed with PIMS according to the criteria of the World Health Organization at the National Institute of Pediatrics, from March 2020 to December 2021. Results: During the study period, 77 patients with PIMS were diagnosed. The results showed correlation between the shock state and alteration of laboratory markers (platelets 144217.29 ± 139321.6 μL [p < 0.001], procalcitonin 27.37 ± 38.37 ng/ml [p = 0.05] and ferritin 1937.87 ± 2562.63 [p < 0.001]). The ventricular function in patients with shock was significantly lower compared to those without shock (49.6 ± 9.1% vs. 58.1 ± 8.4 %; t-Student p < 0.001), as well as injury to the left coronary artery (p = 0.02). There is a correlation between NT-proBNP and ventricular dysfunction (Kruskal-Wallis p = 0.007). Statistical significance was found in the association between death, elevation of inflammatory markers and ventricular dysfunction (p < 0.001). Conclusions: The cardiovascular alterations observed, in order of frequency, were pericardial effusion (25.7%), myocarditis (15%), mild ventricular dysfunction (13.5%) and small coronary aneurysm with predominance of the left coronary artery and the anterior descending one.

Keywords: Multisystem inflammatory syndrome. Pediatrics. Cardiovascular disorders. COVID-19.