Pediatric Heart Disease

1357762 - Determining Predictors of Abnormal Cardiac MRI Findings in Pediatric Patients with COVID-19

Thursday, January 26, 2023

4:30 PM – 5:10 PM

Location: Pacific Jewel

Presenting Author(s)

SR

Summer Rye-Buckingham, MD

Fellow Physician
University of Florida Congenital Heart Center
Gainesville, Florida, United States

Primary Author(s)

Jennifer Co-Vu, MD

Associate Professor
University of Florida
Gainesville, Florida, United States

Co-Author(s)

TV

Terrie Vasilopoulos, PhD

Research Associate Professor
University of Florida, United States

Disclosure(s):

Jennifer Co-Vu, n/a: No financial relationships to disclose

Background: COVID-19 infection is known to cause acute myocarditis, cardiomyopathy, ventricular arrhythmia, heart failure, and cardiogenic shock. As the COVID-19 pandemic continues, we are still learning about the extent of myocardial involvement in pediatric patients with a history of COVID-19 infection, especially those with persistent symptoms. Adult studies have suggested that up to 80% of adults hospitalized with COVID-19 have abnormal left ventricular global longitudinal strain (LVGLS) on transthoracic echocardiogram (TTE). These findings have been used to predict myocardial involvement. Further adult studies proposed that up to 80% of patients who recovered from COVID-19 will have abnormal cardiac MRI (CMR) findings. Multimodality cardiac imaging findings have long term prognostic implications, especially in pediatric patients. This study aims to determine if patient symptoms are associated with abnormal CMR findings and to determine if subclinical evidence of cardiac involvement on CMR could be predicted in pediatric patients with a history of COVID-19 or MIS-C using LVGLS from echocardiogram.

Methods: This study was a retrospective chart review of pediatric patients ≤18 years with history of COVID-19 who underwent CMR and TTE at our institution from 2020 to 2022. Their initial presentation and presenting cardiac symptoms were reviewed. Left ventricle ejection fraction (LVEF) and LVGLS were obtained from TTE at time of presentation. CMR was used to evaluate for signs of myocardial involvement, including late gadolinium enhancement (LGE) and parametric mapping (T1 & T2 mapping and extracellular volume). Those patients that did not have LVGLS on TTE or LGE or parametric mapping on CMR were excluded. Comparisons between patient groups were made using Fischer exact test and Mann Whitney test; p< 0.05 is significant.

Results: A total of 47 patients were identified during the study period. 24 patients were included in this study, ages 9-18 years (mean 14 + 4). 14 (58%) of these patients have abnormal CMR findings (+LGE and/or abnormal parametric mapping). 83% of patients have isolated or combination of symptoms: 13 (54%) presented with chest pain, 10 (42%) with palpitations, 10 (42%) with dyspnea on exertion and 5 (21%) with dizziness. Of all the symptoms, chest pain is significantly associated with abnormal CMR findings (p< 0.0045). All patients have normal LVEF (≥ 55%) by TTE and CMR. Of 14 patients with abnormal CMR, mean LVGLS was -16.6 + 2.1 and 10 patients with normal CMR, the mean LVGLS was -19.5 + 2.8. There was significant difference in LVGLS when comparing patients with abnormal CMR versus normal CMR findings (p< 0.01).

Conclusion: In pediatric patients with history of COVID-19, chest pain, compared to other cardiac symptoms, is significantly associated with abnormal CMR findings. Abnormal LVGLS on TTE despite normal LVEF is also associated with abnormal CMR findings. This has implications when evaluating COVID-19, which can help guide further clinical evaluation and management.