Long term cardiovascular effects on COVID-19 infection in children. The need for monitoring

Abstract

Background: Although SARS-CoV-2 infection has been associated with mild illness in children, concerns have emerged regarding potential long-term cardiovascular and systemic effects, even in previously healthy pediatric populations. Objective: The aim of this study is to assess cardiac function and long-term symptoms in children up to one year after COVID-19 infection, and to compare these findings with healthy controls without prior SARS-CoV-2 exposure. Methods: In this prospective case-control study, children aged 4–17 years were divided into two groups: those with a confirmed history of COVID-19 (Group 1) and healthy controls (Group 2). Participants underwent echocardiographic evaluation—including global longitudinal strain (GLS) analysis and biochemical testing, including lipid profile and intracellular adhesion molecule −1 (ICAM-1) measurements. A structured symptom survey was used to assess cardiovascular and systemic long-COVID manifestations. Results: Conventional echocardiographic indices did not differ significantly between groups. However, Group 1 showed a persistent reduction in left ventricular GLS, indicating subclinical myocardial dysfunction (p < 0.05). Long-COVID symptoms were reported in 23.6% of children in Group 1, with fatigue being the most common (16.6%), followed by palpitations (2.0%). Lipid profiles were similar between groups, although children with moderate to severe infections exhibited significantly elevated serum intracellular adhesion molecule-1 (sICAM-1) levels, suggestive of endothelial activation. Conclusion: Even in the absence of overt cardiovascular disease, children with prior SARS-CoV-2 infection experience persistent subclinical cardiac changes and symptoms consistent with Long-COVID. These findings highlight the need for ongoing surveillance and comprehensive cardiovascular assessments in pediatric populations following COVID-19 infection.