Changes in cardiac functions and morphology in meningococcal infection in children

M.V. Bykov^1,2, V.V. Lazarev¹, I.A. Soldatova³, O.B. Murzina³, I.V. Zakharova³, E.N. Velikanova³, D.V. Chernyshov³, V.V. Serova³, S.V. Nikolaeva², T.A. Ruzhentsova^2,4, A.V. Gorelov^2,5

¹Pirogov Russian National Research Medical University, Moscow

²Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

³Infectious Clinical Hospital No. 2, Moscow

⁴Medical University “REAVIZ”, Moscow

⁵Sechenov University, Moscow

Aim: to assess the effect of meningococcal infection on heart morphology and functions.

Patients and Methods: morphological and functional changes of cardiovascular system were assessed in 18 children aged 7 months to 13 years with meningococcal infection by transthoracic echocardiography. Interventricular septal wall thickness and structure at systole and diastole, left ventricle posterior wall thickness and structure, valve dimensions, parameters of central hemodynamics (i.e., left ventricle end-diastolic diameter, left ventricle end-systolic diameter, left ventricular ejection fraction, stroke volume, and cardiac output), and the ratio of stroke volume to body weight (ml/kg) were measured. The measurements were performed twice, i.e., at admission (within the first 2 or 3 days) and before discharge.

Results: at baseline, the parameters of central hemodynamics were within normal limits in all patients. In 15 children, these parameters have increased. Ejection fraction, stroke volume, and the ratio of stroke volume to body weight have increased while cardiac output have demonstrated no significant changes due to the baseline compensatory tachycardia. Hypertrophy of interventricul ar septum and left ventricle posterior wall with heterogeneous myocardial echogenicity was revealed in 14 patients and 9 patients, respectively. At baseline, 12 patients were diagnosed with mitral valve thickening to 4.7–6.6 mm.

Conclusions: typical changes of heart morphology in acute meningococcal infection demonstrate the presence of cardiodepressive component which accounts for specific infectious toxic cardiomyopathy and reduced myocardial contractility. Reduced ratio of stroke volume to body weight (less than 1 ml/kg) should be considered as a sign of cardiac decompensation and threatened heart failure which require intensive care.

Keywords: children, cardiomyopathy, meningococcal infection, echocardiography.

For citation: Bykov M.V., Lazarev V.V., Soldatova I.A. et al. Changes in cardiac functions and morphology in meningococcal infection in children. RMJ. 2019;10:52–55.