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Nv B, McCollum S, Faherty E, Steele JM, Karnik R. Longitudinal Assessment of Left Ventricular Function in Patients with Myopericarditis After mRNA COVID-19 Vaccination. Pediatr Cardiol 2023:10.1007/s00246-023-03200-2. [PMID: 37294336 PMCID: PMC10251331 DOI: 10.1007/s00246-023-03200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited. OBJECTIVES Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters. METHODS Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test. RESULTS Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was -18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and -20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0). CONCLUSIONS Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.
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Affiliation(s)
- Barresi Nv
- Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| | - S McCollum
- Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA
| | - E Faherty
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - J M Steele
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - R Karnik
- Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA
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Pareek M, Steele J, Asnes J, Baldassarre LA, Casale LR, Desai NR, Elder RW, Faherty E, Ferguson I, Fishman RF, Ghazizadeh Z, Glick LR, Hall EK, Khera R, Kokkinidis DG, Kwan JM, O'Marr J, Schussheim A, Tuohy E, Wang Y, Spatz ES, Jacoby D, Miller EJ. Short-Term Outcomes After Myopericarditis Related to COVID-19 Vaccination. JACC Cardiovasc Imaging 2022; 15:2002-2005. [PMID: 36357140 PMCID: PMC9094612 DOI: 10.1016/j.jcmg.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Manan Pareek
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeremy Steele
- Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeremy Asnes
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lauren A Baldassarre
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linda R Casale
- Department of Cardiology, Bridgeport Hospital, Yale School of Medicine, Bridgeport, Connecticut, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert W Elder
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erin Faherty
- Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ian Ferguson
- Department of Pediatric Rheumatology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert F Fishman
- Department of Cardiology, Bridgeport Hospital, Yale School of Medicine, Bridgeport, Connecticut, USA
| | - Zaniar Ghazizadeh
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura R Glick
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - E Kevin Hall
- Department of Pediatric Cardiology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer M Kwan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jamieson O'Marr
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Adam Schussheim
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward Tuohy
- Department of Cardiology, Bridgeport Hospital, Yale School of Medicine, Bridgeport, Connecticut, USA
| | - Yanting Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel Jacoby
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.
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Beach CM, Faherty E, Pesce M. Coronavirus disease 2019 and the young heart: prevention, treatment, and return to play. Curr Opin Pediatr 2022; 34:471-475. [PMID: 36036422 PMCID: PMC9593324 DOI: 10.1097/mop.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW COVID-19-related guidance has changed dramatically since the onset of the pandemic. Awareness of data regarding prevention of disease, the cardiac manifestations and treatment of acute COVID-19 and multisystem inflammatory syndrome in children, and return to physical activity following an infection allows for appropriate adjustment of current care models and guides future study. RECENT FINDINGS Severe acute respiratory syndrome coronavirus 2 transmission can be reduced using various mitigation strategies, though their effectiveness differs based on viral prevalence. The risk of severe disease during acute COVID-19 infection is low in children and adolescents, though specific risk factors have been identified. COVID-19 vaccination significantly decreases the risk of severe disease and poor outcomes. Regular physical activity positively affects well being and has been a focus of recent guidance regarding well tolerated return to activities following an infection. SUMMARY The use of strategies to reduce viral transmission will depend on individuals' and communities' risk tolerance and on current viral prevalence. COVID-19 vaccination should be encouraged, particularly in patients with identified risk factors. Allowing children and adolescents to safely participate in physical and other activities should continue to be a focus of our clinical and research efforts given their myriad benefits in this population.
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Affiliation(s)
- Cheyenne M Beach
- Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
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Faherty E, Rajagopal H, Lee S, Love B, Srivastava S, Parness IA, Uppu SC. Correlation of transthoracic echocardiography-derived pulmonary to systemic flow ratio with hemodynamically estimated left to right shunt in atrial septal defects. Ann Pediatr Cardiol 2022; 15:20-26. [PMID: 35847407 PMCID: PMC9280094 DOI: 10.4103/apc.apc_139_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transthoracic echocardiographic (TTE) estimation of the pulmonary to systemic flow ratio (Qp/Qs) is routinely used in clinical practice and is included in the American Society of Echocardiography Guidelines. We sought to assess its real-world applicability with a particular focus on hemodynamically significant shunt lesions. METHODS Retrospective single institutional review of TTE's in patients with secundum atrial septal defect prior to cardiac catheterization (cath) from 2012 to 2018 was performed (n = 109), those with technically limited images for Qp/Qs calculation (n = 11) and those with time interval between TTE and cath >60 days were excluded (n = 14). Qp/Qs was calculated from stored clips by previously described methods and correlated with those obtained by oximetry. Patients were subdivided into two age groups <21 (Group 1) and ≥22 years (Group 2). TTE and cath methods for Qp/Qs estimation were compared using paired t-test, Pearson's correlation coefficient, and Bland-Altman plots. RESULTS Eighty-four subjects met inclusion criteria (age range 3-78 years). Group 1 n = 35; median age 10 years; Group 2 n = 49; median age 49 years. Transthoracic echocardiogram was performed 19.5 ± 15 days prior to cath. Mean Qp/Qs derived by cath and TTE were 2.09 ± 0.9 versus 2.54 ± 1.2 (P < 0.0001). Overall correlation was poor between the methods (r 2 = 0.32, P < 0.0001) and continued to be poor for Groups 1 and 2 (r 2= 0.24, P = 0.003 and r 2= 0.40, P < 0.0001 respectively). Bland-Altman plots demonstrated poor agreement between the predetermined limits of agreement (-0.5-1.5). CONCLUSION Transthoracic echocardiography estimated Qp/Qs, although routinely utilized in clinical practice, has poor correlation and agreement with oximetry-derived Qp/Qs. The test performs poorly in all age groups in detecting a hemodynamically significant shunt and tends to overestimate the degree of left to right shunt.
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Affiliation(s)
- Erin Faherty
- Department of Pediatric Cardiology, Yale New Haven Children's Hospital, New Haven, CT, USA
| | - Hari Rajagopal
- Department of Pediatric Cardiology, Steven and Alexandra Cohen Children's Medical Center, New York, NY, USA
| | - Simon Lee
- Department of Pediatric Cardiology, Nationwide Children's, Columbus, OH, USA
| | - Barry Love
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shubhika Srivastava
- Department of Pediatric Cardiology, Nemours Children's Health System, Wilmington, DE, USA
| | - Ira A. Parness
- Department of Pediatric Cardiology, Steven and Alexandra Cohen Children's Medical Center, New York, NY, USA
| | - Santosh C. Uppu
- Department of Pediatric Cardiology, Children's Heart Institute, UTHealth Houston, McGovern Medical School, Houston, TX, USA,Address for correspondence: Dr. Santosh C Uppu, 6410, Fannin Street, Suite 425 Houston, Tx 77030, USA. E-mail:
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He M, Leone DM, Frye R, Ferdman DJ, Shabanova V, Kosiv KA, Sugeng L, Faherty E, Karnik R. Longitudinal Assessment of Global and Regional Left Ventricular Strain in Patients with Multisystem Inflammatory Syndrome in Children (MIS-C). Pediatr Cardiol 2022; 43:844-854. [PMID: 34993558 PMCID: PMC8739007 DOI: 10.1007/s00246-021-02796-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is one of the most significant sequela of coronavirus disease 2019 (COVID-19) in children. Emerging literature has described myocardial dysfunction in MIS-C patients using traditional and two-dimensional speckle tracking echocardiography in the acute phase. However, data regarding persistence of subclinical myocardial injury after recovery is limited. We aimed to detect these changes with deformation imaging, hypothesizing that left ventricular global longitudinal (GLS) and circumferential strain (GCS) would remain impaired in the chronic phase despite normalization of ventricular function parameters assessed by two-dimensional echocardiography. A retrospective, single-institution review of 22 patients with MIS-C was performed. Fractional shortening, GLS, and GCS, along with regional longitudinal (RLS) and circumferential strain (RCS) were compared across the acute, subacute, and chronic timepoints (presentation, 14-42, and > 42 days, respectively). Mean GLS improved from - 18.4% in the acute phase to - 20.1% in the chronic phase (p = 0.4). Mean GCS improved from - 19.4% in the acute phase to - 23.5% in the chronic phase (p = 0.03). RCS and RLS were impaired in the acute phase and showed a trend towards recovery by the chronic phase, with the exception of the basal anterolateral segment. In our longitudinal study of MIS-C patients, GLS and GCS were lower in the acute phase, corroborating with left ventricular dysfunction by traditional measures. Additionally, as function globally recovers, GLS and GCS also normalize. However, some regional segments continue to have decreased strain values which may be an important subclinical marker for future adverse events.
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Affiliation(s)
- Michael He
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | - David M. Leone
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Richard Frye
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Dina J. Ferdman
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Veronika Shabanova
- grid.47100.320000000419368710Department of Pedatrics, Department of Biostatistics, Yale School of Medicine, New Haven, CT USA
| | - Katherine A. Kosiv
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Lissa Sugeng
- grid.47100.320000000419368710Department Medicine, Section of Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Erin Faherty
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Ruchika Karnik
- grid.47100.320000000419368710Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, CT USA
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Marshall M, Ferguson ID, Lewis P, Jaggi P, Gagliardo C, Collins JS, Shaughnessy R, Caron R, Fuss C, Corbin KJE, Emuren L, Faherty E, Hall EK, Di Pentima C, Oster ME, Paintsil E, Siddiqui S, Timchak DM, Guzman-Cottrill JA. Symptomatic Acute Myocarditis in 7 Adolescents After Pfizer-BioNTech COVID-19 Vaccination. Pediatrics 2021; 148:peds.2021-052478. [PMID: 34088762 DOI: 10.1542/peds.2021-052478] [Citation(s) in RCA: 245] [Impact Index Per Article: 81.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
Trials of coronavirus disease 2019 (COVID-19) vaccination included limited numbers of children, so they may not have detected rare but important adverse events in this population. We report 7 cases of acute myocarditis or myopericarditis in healthy male adolescents who presented with chest pain all within 4 days after the second dose of Pfizer-BioNTech COVID-19 vaccination. Five patients had fever around the time of presentation. Acute COVID-19 was ruled out in all 7 cases on the basis of negative severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction test results of specimens obtained by using nasopharyngeal swabs. None of the patients met criteria for multisystem inflammatory syndrome in children. Six of the 7 patients had negative severe acute respiratory syndrome coronavirus 2 nucleocapsid antibody assay results, suggesting no previous infection. All patients had an elevated troponin. Cardiac MRI revealed late gadolinium enhancement characteristic of myocarditis. All 7 patients resolved their symptoms rapidly. Three patients were treated with nonsteroidal antiinflammatory drugs only, and 4 received intravenous immunoglobulin and corticosteroids. In this report, we provide a summary of each adolescent's clinical course and evaluation. No causal relationship between vaccine administration and myocarditis has been established. Continued monitoring and reporting to the US Food and Drug Administration Vaccine Adverse Event Reporting System is strongly recommended.
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Affiliation(s)
- Mayme Marshall
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Ian D Ferguson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Paul Lewis
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Preeti Jaggi
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Christina Gagliardo
- Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey.,Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Robin Shaughnessy
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Rachel Caron
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Cristina Fuss
- Department of Radiology, Oregon Health and Science University, Portland, Oregon
| | | | - Leonard Emuren
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Erin Faherty
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - E Kevin Hall
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Cecilia Di Pentima
- Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey.,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew E Oster
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Elijah Paintsil
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Saira Siddiqui
- Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey
| | - Donna M Timchak
- Goryeb Children's Hospital, Atlantic Health System, Morristown, New Jersey.,Irving Medical Center, Columbia University, New York, New York
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Faherty E, Rajagopal H, Uppu S, Geiger M, Srivastava S. FETAL ASSESSMENT OF A RIGHT AORTIC ARCH: IMPACT ON OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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