Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19

The study, “Mid- and Long-Term Atrio-Ventricular Functional Changes in Children after Recovery from COVID-19,” aimed to evaluate cardiac mechanics in children who recovered from SARS-CoV-2 infection using two-dimensional speckle-tracking echocardiography (STE).

Here are the key findings and conclusions:

  1. Study Design: Conducted at the University of Padua, Italy, this observational prospective study included 157 pediatric patients (mean age 7.7 years) who had laboratory-confirmed SARS-CoV-2 infection and were asymptomatic or mildly symptomatic. These patients were compared with 107 age- and body surface area (BSA)-comparable healthy controls​​​​.
  2. Cardiac Evaluations: The study found no significant differences in left ventricular (LV) dimensions, global systolic and diastolic function, left atrial volume indexed to BSA (LAVi), and right ventricular longitudinal function between post-COVID-19 patients and controls​​.
  3. Left Ventricular Longitudinal Strain: Global longitudinal strain was significantly reduced in children in the post-COVID-19 group compared to controls. This reduction was noted despite being within the normal range. Additionally, regional longitudinal strain was significantly reduced in LV apical-wall segments in children affected during the second wave of the pandemic compared to the first wave​​.
  4. Left Atrial Reservoir Strain: Peak left atrial systolic strain values were within the normal range in the post-COVID-19 group, with no significant differences compared to controls​​.
  5. Discussion and Implications: The study revealed that 60% of children who recovered from asymptomatic or mildly symptomatic COVID-19 exhibited mild subclinical systolic cardiac impairment after an average follow-up of 148 ± 68 days. This impairment was more pronounced in children who recovered during the second wave of the pandemic. The findings suggest that subclinical left ventricular dysfunction may be a characteristic of COVID-19 infection in children, raising concerns due to the predictive value of LV longitudinal strain in the general population​​.
  6. Conclusions: The study demonstrated the persistence of LV myocardial deformation abnormalities after recovery from an asymptomatic or mildly symptomatic COVID-19 course in previously healthy children. These myocardial alterations were more pronounced during the second wave of COVID-19, indicating that subclinical LV dysfunction might complicate even mild COVID-19 cases in children​​.


This study presents crucial insights into the cardiac impact of COVID-19 on children. Despite experiencing mild or no symptoms, a significant proportion of children showed subtle yet persistent changes in cardiac mechanics after recovery. The use of advanced echocardiography techniques revealed these subclinical myocardial deformations, particularly in the left ventricular region. These findings are pivotal as they suggest that even mild COVID-19 in children might lead to cardiac alterations, which could have long-term implications on pediatric health. The study underscores the need for ongoing cardiac monitoring in children who have recovered from COVID-19, especially considering the potential risks associated with reduced left ventricular strain.

Read More: https://www.mdpi.com/2077-0383/12/1/186

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