小儿多系统炎症综合征队列的纵向超声心动图随访。

J. Ramamoorthy, Anantharaj Avinash, Pediredla Karunakar, C. Parale, Ramanathan Velayutham, Suresh Kumar Sukumaran, Sridhar Balaguru, N. Parameswaran, Mugunthan M, Rahul Dhodapkar, Debdatta Basu, Raja Selvaraj, S. Satheesh, N. Biswal
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摘要

目的众所周知,儿童多系统炎症综合征(MIS-C)会严重累及心血管系统。本研究旨在考察中期随访期间受影响心血管参数的恢复情况。方法对 69 名儿童进行了前瞻性研究。分别在入院、1.5个月和3个月时对左心室(LV)功能和冠状动脉异常(CAA)进行了评估。在这三个时间点对冠状病毒病 2019(COVID-19)抗体滴度进行了评估。分析了超声心动图和抗体参数(上升/下降)之间的相关性。结果入院时,78.2% 的患者接受了检测,其中 88.9% 的患者严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)检测呈阳性。四分之一的患者有心包积液,一半有瓣膜炎。分别有 54.4%、68.6% 和 35.8% 的患者出现射血分数、全周应变 (GCS) 和全纵应变 (GLS) 下降。27.78%的患者出现 CAA。收缩功能障碍与年龄明显相关。随访期间,严重左心室功能障碍在 6-7 周内恢复正常,而轻度至中度功能障碍在两周内恢复正常。GCS和GLS均在中位两周内恢复正常。舒张参数在六周内恢复正常。大多数小型和中型冠状动脉瘤都已消退,但一名婴儿的巨大动脉瘤在 15 个月后仍然很大。抗体的变化趋势与三个月时的射血分数(EF)明显相关。入院时的射血分数、GLS(6周时)和减速时间(3个月时)与入住重症监护室(ICU)密切相关。结论 较小的 CAA 可以缓解,而巨大的 CAA 则持续存在。EF和GLS是预测儿科重症监护室(PICU)住院时间的重要指标。中位节段应变的残余损伤和三个月时持续存在的舒张功能障碍表明需要进行长期随访。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Longitudinal Echocardiographic Follow-Up of a Pediatric Multisystem Inflammatory Syndrome Cohort.
OBJECTIVE Significant involvement of the cardiovascular system is known in multisystem inflammatory syndrome in children (MIS-C). This study aimed to examine the recovery of affected cardiovascular parameters over a medium-term follow-up. METHODS A cohort of 69 children was studied prospectively. Assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) were conducted at admission, 1.5 months, and 3 months. Coronavirus Disease 2019 (COVID-19) antibody titers were assessed at these three time points. Echocardiographic and antibody parameters (rising/decreasing) were analyzed for correlation. Outcomes were assessed using logistic regression. RESULTS At admission, among the 78.2% of patients who were tested, 88.9% tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A quarter of the patients had pericardial effusion, and half had valvulitis. Decreased ejection fraction, global circumferential strain (GCS), and global longitudinal strain (GLS) were seen in 54.4%, 68.6%, and 35.8% of patients, respectively. CAAs were observed in 27.78% of patients. Systolic dysfunction was significantly associated with older age. During follow-up, severe LV dysfunction normalized within 6-7 weeks, while mild to moderate dysfunction reached normalcy by two weeks. Both GCS and GLS reached normalcy within a median of two weeks. Diastolic parameters recovered by six weeks. Most small and moderate coronary aneurysms resolved, but a giant aneurysm in an infant remained large even after 15 months. Trends in antibodies and ejection fraction (EF) at three months were significantly correlated. Admission EF, GLS (at 6 weeks) and deceleration time (at 3 months) were significantly associated with intensive care unit (ICU) admission. The median segmental strain of the cohort remained low in certain segments at three months. CONCLUSION Smaller CAAs resolve, whereas giant CAAs persist. EF and GLS are important predictors of Pediatric Intensive Care Unit (PICU) stay. The residual impairment of median segmental strain and persistent diastolic dysfunction at three months indicate the need for long-term follow-up.
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