Document Type : Original Article

Authors

• Mohammad Mehdi Bagheri ¹
• Reza Sinaei ^{1, 2}
• Fateme Dortaj ³
• Mehran Ilaghi ⁴
• Shirin Aboutalebi ⁵

¹ Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

² Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

³ Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

⁴ Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran

⁵ Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: Cardiovascular involvement represents a potentially serious complication associated with novel coronavirus disease 2019 (COVID-19), particularly among pediatric patients. Data regarding echocardiographic findings remain sparse, especially in low- and middle-income countries. The primary objective of this study was to investigate the echocardiographic findings of hospitalized children with COVID-19 in southeast Iran.
METHODS: This was a cross-sectional study of hospitalized pediatric COVID-19 patients in Kerman, southeast Iran, between March 2020 and March 2022. Clinical records of patients who had undergone transthoracic echocardiograms were evaluated. Demographic and clinical data, as well as echocardiographic findings—including left ventricular (LV) dysfunction, coronary involvement, valvular abnormalities, and pericardial effusion—were noted. Serum inflammatory markers were also assessed.
RESULTS: Data from a total of 188 children were analyzed. The mean age (± standard deviation) was 52.7 ± 4.9 months, and 61.4% were male. In terms of disease severity, 36.1% were categorized as moderate, 47.9% as severe, and 16.0% as multisystem inflammatory syndrome in children (MIS-C). Overall, 92.0% had abnormal echocardiographic findings—most commonly pericardial effusion (55.9%), valvular dysfunction (44.1%), coronary artery involvement (36.7%), and LV dysfunction (19.1%). Mitral regurgitation (36.2%) and tricuspid regurgitation (19.7%) were the most common valvular involvements. Moreover, coronary ectasia (19.7%) and dilatation (13.3%) were the prominent coronary abnormalities. LV dysfunction and valvular abnormalities were associated with increased mechanical ventilation, ICU admission, and mortality. Elevated erythrocyte sedimentation rate (ESR) was associated with valvular dysfunction, while higher NT-proBNP was associated with LV dysfunction.
CONCLUSION: Hospitalized children had a high prevalence of echocardiographic abnormalities, with LV and valvular dysfunction correlating with worse prognosis and inflammation. Echocardiography appears valuable for risk stratification in ventilator support and Intensive Care Unit (ICU) admission in pediatric patients; however, further research is needed on long-term cardiac sequelae.

Keywords

• COVID-19
• Children
• Echocardiography
• Cardiac Manifestations