O1026: Cardiac Evaluation of All Hospitalized Children with 2019 Coronavirus Infection, Irrespective of Cardiac Concerns: A Single Large Quaternary Center Study

Background: Cardiac complications of serious COVID-19 infections, especially Multisystem Inflammatory Syndrome of Children (MIS-C) are well described, however current studies have not considered pediatric patients hospitalized with no cardiac concerns (e.g. symptoms, abnormal electrocardiogram or elevated troponin). We established a protocol for cardiac evaluation of all admitted COVID-19 patients three weeks post-discharge, irrespective of cardiac concerns. We assessed cardiovascular outcomes and hypothesized that patients with absent cardiac concerns are at lower risk for cardiac abnormalities.

Methods: This is a retrospective study of patients admitted to a large quaternary free-standing hospital for COVID-19 (excluding MIS-C) between 03/2020 and 09/2021 with subsequent echocardiogram(s). Patients were divided into 4 subgroups: Group 1 included admitted patients with absent cardiac concerns, admitted to acute care (1a) and intensive care unit (ICU) (1b). Group 2 included admitted patients with cardiac concerns, admitted to acute care (2a) and ICU (2b). Groups were compared based on clinical endpoints and echocardiographic measurements, including Tissue Doppler (TDI) assessment of diastolic function (z-score of septal Mitral E/TDI E’ and lateral E/TDI E'). Chi-squared, Fisher’s exact, and Kruskal-Wallis tests were used.

Results: Groups 1a (n=66) and 2a (n=34) were younger than those admitted to ICU (p=0.001). They also had less diabetes (p=0.048) and less symptoms of shortness of breath (p=0.003). ICU-admitted patients, Groups 1b (n=22) and 2b (n=39), had more patients receiving steroids (p < 0.001), remdesivir (p < 0.001), required more oxygen therapy (p < 0.001), and had longer hospital course (p < 0.001). Traditional cardiac abnormalities (pericardial effusion, systolic function, valvular regurgitation, and coronary artery dilation) were most common in Group 2b (n=8, 21%), but still found in Group 1a (n=2, 3%) and Group 1b (n=1, 5%). No patients in Group 1 demonstrated abnormal systolic function, compared to Group 2a (n=1, 3%) and Group 2b (n=3, 9%, p=0.051). There were similar rates of abnormal diastolic function in Group 1a (n=12, 18%), Group 1b (n=3, 14%), Group 2a (n=9, 26%), and Group 2b (n=12, 31%) (Tables 1, 2).

Conclusion: Cardiac abnormalities were still found in pediatric patients admitted with COVID-19 infection and with no apparent cardiovascular concerns. The risk is still greatest in ICU-admitted patients with cardiac concerns. The clinical significance of diastolic function assessment in these patients remains unknown. Further studies are needed to assess long-term cardiovascular sequelae of children with COVID-19 infections, irrespective of cardiac concerns.