Evaluacija koronarnih arterija i imunološkog statusa kod post-COVID-19 djece u Sarajevu

Introduction: Although evidence has demonstrated that SARS-COV-2 primarily affects the upper respiratory tract, other systems are also involved such as gastrointestinal and cardiovascular system. At present, there is insufficient data on cardiovascular and immunologic involvement in COVID-19 paediatric patients. Patients and Methods: This study evaluated 70 children previously healthy or with no pre-existing heart disease from Sarajevo with positive post-COVID history. Detailed cardiovascular examination was performed, with parameters of body weight, height, oxygen saturation, pulse, blood pressure, electrocardiogram (ECG), 24hrs Holter ECG, echocardiography. Laboratory tests included values of polymerase chain reaction (PCR) and SARS-COV-2 immunoglobulin G /IgG/ and immunoglobulin M /IgM/, CBC /complete blood count/, creatinine phosphokinase myofibrilae /CPKMB/, creatinine phosphokinase/CPK/, lactate dehydrogenase /LDH/, liver enzymes, D dimer, C reactive protein/CRP/ and urine. Results: Majority of children (64.3%) were asymptomatic. ECG was normal in relation to patients’ age, except in eight patients (intermittent palpitations on exertion): short PR interval, so in 24hrs ECG Holter there was no significant arrhythmias except incomplete right branch block / IRBB/ in 12%, monofocal ventricular ectopicextrasystole /VES/ in 15%. Echocardiogram was normal in all patients with normal ejection fraction of the left ventricle, no pericardial effusion, vegetations or thrombus was detected. Mean diameter of coronary arteries right /RCA/ and left /LCA/ ranged from 1.98 mm to LCA 2.09 mm except in one symptomatic patient a diameter of left coronary artery /LCA/ was enlarged up to 3.8 mm. The concentration levels of COVID-19 IgG showed a statistical significance when compared between younger and older age groups in examined children (p < 0.05; p = 0.043). Conclusion: Cardiovascular evaluation should always be an option in post-COVID patients. Immunological assessment is necessary in post-COVID patients in order to gain a further understanding of patient’s statusUvod: Iako su rezultati studija pokazali da SARS-COV-2 prvenstveno utiče na gornje respiratorne puteve, uključeni su i gastrointestinalni i kardio vaskularni sistem. Trenutno,nema dovoljno podataka o kardiovaskularnoj i imunološkoj zahvaćenosti kod COVID19 pedijatrijskih pacijenata. Pacijenti i metode: U studiji je učestvovalo 70 djece iz Sarajeva, koja su prethodno bila zdrava ili nisu imala srčane bolesti, s pozitivnom anamnezom nakon COVID-a. Urađen je detaljan kardiovaskularni pregled, uz parametre tjelesne težine, visine, mjerenja saturacije kiseonika, pulsa, krvnog pritiska, elektrokardiogram (EKG), 24 satni Holter EKG, ehokardiografija i laboratorijski testovi koji su uključivali vrijednosti lančane reakcije polimeraze (PCR) i SARS-COV-2 imunoglobulina G /IgG/ i imunoglobulin M /IgM/, KKS /kompletna krvna slika/, kreatinin fosfo kinaza miofibrila /CPKMB/, kreatinin fosfokinaza /CPK/, laktat dehidrogenaza /LDH/, enzimi jetre, D-dimer, C reaktivni protein /CRP/ i urin. Rezultati: Većina djece (64.3%) bila je asimptomatska. EKG je bio uredan u odnosu na dob pacijenata osim kod osam pacijenata /intermitentne palpitacije na napor/sa skraćenim PR intervalom, a u 24h Holter EKG nije bilo signifikantne aritmije osim u 12% inkompletan blok desne grane i kod 15% monofokalne ventrikularne ektopične ekstrasistole. Ehokardiogram je bio uredan kod svih pacijenata sa normalnom ejekcionom frakcijom lijeve komore, bez perikardne efuzije, vegetacije ili tromba. Prosječan dijametar koronarnih arterija desne i lijeve je iznosio od 1.98 mm do 2.09 mm osim kod jednog simptomatskog pacijenta: uvećan dijametar lijeve koronarne arterije / LKA/ do 3.8 mm. Nivoi koncentracije COVID-19 IgG pokazali su statističku značajnost u poređenju između mlađe i starije starosne grupe kod ispitivane djece (p