Can a juvenile develop left ventricular hypertrophy from COVID-19 (Coronavirus Disease 2019) despite having mild symptoms?

Left Ventricular Hypertrophy in Juveniles After Mild COVID-19

Juveniles with mild COVID-19 symptoms typically do not develop true left ventricular hypertrophy, but may experience transient myocardial edema that mimics hypertrophy as part of COVID-19-related cardiac involvement. 1

Mechanisms of Cardiac Involvement in Juveniles with COVID-19

• COVID-19 can affect the heart through multiple pathways including direct viral injury to myocytes, inflammatory cascades, and systemic hyperinflammatory responses 1
• Apparent ventricular "hypertrophy" in COVID-19 is typically due to myocardial edema rather than true myocyte hypertrophy 1
• Cardiac involvement in mild COVID-19 cases is generally subclinical and often resolves without long-term consequences 2

Evidence of Cardiac Involvement in Juveniles with Mild COVID-19

• Studies have demonstrated subclinical left ventricular dysfunction in previously healthy children with asymptomatic or mildly symptomatic COVID-19 infection 3
• Research shows that 26% of children with asymptomatic or mild COVID-19 may have regional left ventricular strain abnormalities when assessed at least 3 months after infection 4
• Left ventricular global longitudinal strain (LVGLS) may be reduced in patients after COVID-19 infection, even in those with mild symptoms 5

Diagnostic Considerations

• Echocardiography is the first-line imaging modality for evaluating potential cardiac involvement in juveniles with COVID-19 1
• Key diagnostic findings that may indicate COVID-related myocardial involvement include:
  • Increased LV wall thickness (mimicking hypertrophy)
  • Abnormal ventricular strain patterns
  • Elevated cardiac biomarkers (troponin, BNP) 2, 1
• Cardiac MRI should be considered in cases with suspected myocarditis or persistent cardiac symptoms, as it can detect myocardial edema and inflammation 2

Clinical Course and Prognosis

• Most juveniles with mild COVID-19 do not develop clinically significant cardiac complications 6
• When cardiac involvement does occur, it typically resolves without long-term sequelae in most pediatric patients 6
• The American College of Cardiology guidelines note that myocardial dysfunction may be present in up to 40% of hospitalized COVID-19 patients, but fulminant myocarditis is rare 2

Special Considerations for Pediatric Athletes

• Athletes who have recovered from COVID-19 should undergo cardiac screening before returning to play, even if they had mild symptoms 2
• Screening may include ECG, troponin testing, and echocardiography to rule out myocardial involvement 2
• Isolated LV enlargement is not a characteristic feature of exercise-induced cardiac remodeling and should prompt further evaluation 2

Monitoring and Follow-up

• Children who had mild COVID-19 with suspected cardiac involvement should have follow-up echocardiography to ensure resolution of any abnormalities 2
• Serial laboratory testing and cardiac assessment should guide treatment decisions in cases with confirmed cardiac involvement 2
• For patients with significant cardiac involvement, echocardiograms should be repeated at 7-14 days and 4-6 weeks after presentation 2

Multisystem Inflammatory Syndrome in Children (MIS-C)

• MIS-C is a distinct entity from mild COVID-19 and is associated with more severe cardiac involvement 2
• Left ventricular dysfunction has been reported in 20-55% of MIS-C cases 2, 1
• MIS-C typically occurs 2-6 weeks after COVID-19 infection and presents with more severe systemic symptoms 2

While mild COVID-19 in juveniles rarely causes true left ventricular hypertrophy, subclinical cardiac involvement can occur and should be monitored in symptomatic cases or those with abnormal cardiac biomarkers.