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letter
. 2020 Oct 10;27(4):648–650. doi: 10.1016/j.cmi.2020.10.005

Table 1.

Demographic, clinical characteristics, ancillary tests, treatmenta and outcomes of children with PIMS-TS and heart dysfunction

Variable Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Demographics and epidemiology
Age (years) 6 9 5 7 12
Sex Male Male Female Female Male
Ethnicity Sub-Saharan African Arabic Hispanic Caucasian Caucasian
Medical history Healthy Psoriasis Healthy Healthy Tonsillectomy
Family cluster of SARS-CoV-2 infection No Yes Yes Yes Yes
Signs and symptoms at admission
Temperature (°C) 40.3 38.5 40.2 39.3 40.7
Days of fever before admission (>38°C) 5 7 5 6 5
Rash Yes Yes Yes No Yes
Distribution of the rash Thorax, arms and legs Hands and feet Palms, thorax and legs Palms
Conjunctivitis Yes Yes Yes Yes No
Lymphadenitis No No No No No
Lips Normal Cracked lips Normal Normal Normal
Tongue Normal Normal Normal Normal Normal
Abdominal pain Yes Yes Yes Yes Yes
Diarrhea No Yes Yes Yes Yes
Cough No No No No Yes
Oxygen saturation (%) 87 97 95 98 95
Heart rate (bpm) 125 182 130 116 112
Blood pressure (mmHg) 86/44 75/42 88/46 90/50 87/38
Image and heart evaluation
Chest X-rays Mild left pulmonary infiltrate Normal Normal Normal Normal
Echocardiography (at admission
  • •

    Mild systolic disfunction (LVEF 52%)
  • •

    Moderate systolic disfunction (LVEF 40%)
  • •

    Moderate systolic disfunction (LVEF:40%)
  • •

    Moderate systolic disfunction (LVEF: 40%)
  • •

    Mild systolic disfunction (LVEF 50%)
  • •

    Diastolic dysfunction
  • •

    Diastolic dysfunction
  • •

    Diastolic dysfunction
  • •

    Normal coronary arteries: LCA 2.7mm (z score +0.2) and RCA 2.5mm (z score +0.4).
  • •

    Normal coronary arteries: LCA: 3,8mm (z score +0.6), RCA: 3,4mm (z score +0.5).
  • •

    Normal coronary arteries: LCA 2,4mm (z score -1.6) and RCA 2,3mm (z score -1).
  • •

    Normal coronary arteries: LCA 2,8mm (z score 0), LAD 2,8mm (z score: +1.5) and RCA 2.5mm (z score 0).
  • •

    Severe mitral regurgitation and moderate tricuspid regurgitation
  • •

    Normal coronary arteries: LCA 2,9mm (z score +1.4), LAD 2,2mm (z score +1), RCA 2,7mm (z score +1.5).
Electrocardiogram
  • •

    Normal
  • •

    Repolarization abnormalities
  • •

    Normal
  • •

    Repolarization abnormalities
  • •

    Normal
Treatment Dopamine Dopamine Ceftriaxone Ceftriaxone Norepinephrine
Norepinephrine Cefotaxime Clindamycin IVIG (2gr/kg) Amoxicillin-clavulanate
Ceftriaxone IVIG (2 gr/kg) IVIG (2gr/kg) Steroids (2 mg/kg) IVIG (2gr/kg)
IVIG (2 gr/kg) Steroids (2 mg/kg)
Steroids (2 mg/kg)
Hydroxychloroquine
Azithromycin
PICU admission Yes Yes Yes No Yes
Respiratory support/oxygen therapy BiPAP Nasal cannula Nasal cannula Nasal cannula
Outcome
Echocardiography Complete resolution of abnormalities on day 7 of admission. LVEF 70%. Normal coronary arteries. Complete resolution of abnormalities on day 5 of admission. LVEF 55%. Normal coronary arteries. Evaluation on day 6 of admission. Mild tricuspid regurgitation. Resolution of mitral regurgitation. LVEF 60%. Normal coronary arteries Complete resolution of abnormalities on day 5 of admission. LVEF 70%. Normal coronary arteries Complete resolution of abnormalities on day 8 of admission. LVEF 70%. Normal coronary arteries
Cardiovascular Magnetic Resonance LVEF 60% (EDV 76 ml/m2)
RVEF 57% (EDV 84 ml/m2)
No myocardial edema or enhancement abnormalities		 LVEF 65% (EDV 78 ml/m2)
RVEF 69% (EDV 83 ml/m2)
No myocardial edema or enhancement abnormalities		 LVEF 57% (EDV 70 ml/m2)
RVEF 57% (EDV 73 ml/m2). Mild trycuspid regurgitation.
No myocardial edema or enhancement abnormalities		 LVEF 66% (EDV 64 ml/m2)
RVEF 67% (EDV 63 ml/m2)
No myocardial edema or enhancement abnormalities		 LVEF 66% (EDV 64 ml/m2)
RVEF 67% (EDV 63 ml/m2)
No myocardial edema or enhancement abnormalities

BiPAP, Bilevel Positive Airway Pressure; LAD, Left Anterior Descending; EDV, End-Diastolic Volume; IVIG, Intravenous Immunoglobulin; LCA: Left Coronary Artery; LVEF, Left Ventricular Ejection Fraction; ND, not done; PICU, Pediatric Intensive Care Unit;; RCA: Right Coronary Artery; RVEF: Right Ventricular Ejection Fraction.

Z-score for coronary artery diameters was assessed according to: Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr. 2011 Jan; 24:60-74. https://doi.org/10.1016/j.echo.2010.10.004.