Abstract
BackgroundThe incidence of Kawasaki disease (KD) is increasing. Indeed, KD has become the most common cause of acquired heart disease in children. Previous studies have well summarized the acute phase left ventricular (LV) systolic dysfunction using speckle tracking echocardiography (STE); however, changes in LV systolic function after long-term follow-up remain unclear.MethodsOne hundred children with a history of KD, but without coronary artery aneurysms, were enrolled. These children were divided into two subgroups based on the presence or absence of coronary artery dilatation (CAD). The duration of follow-up was > 7 years. The control group consisted of 51 healthy children. The LV myocardial strain were measured by two- and three-dimensional STE.ResultsTwo-dimensional STE not only revealed that LV longitudinal strain decreased in part of segments in both KD groups, but also showed that global strain decreased in the KD group with CAD compared to the controls (P < 0.05). Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were obtained by 3D STE. Compared to the controls, GLS and GAS decreased in both KD groups (P < 0.05). GCS and GRS decreased in the KD group with CAD, but was unchanged in the KD group without CAD (P < 0.05).ConclusionsLV systolic dysfunction in children with KD and CAD was more severe than KD children without CAD compared to healthy children. This dysfunction can be assessed by LV regional and global myocardial strain using two- and three-dimensional STE.
Highlights
The incidence of Kawasaki disease (KD) is increasing
The differences among the groups with respect to age, heart rate, systolic blood pressure, diastolic blood pressure, body surface area, interval from onsetto-exam, interval from onset-to-intravenous immunoglobulin (IVIG) treatment, and treatment strategy of using cardiovascular drugs (including three strategies: “Aspirin is administered at 80 to 100 mg/kg per day in 4 doses with IVIG”, “low-dose aspirin (3 to 5 mg/kg per day)”, and “2 to 6 mg/kg per day in 3 divided doses” [4], details are shown in Table 1) were not statistically significant (P > 0.05)
The complete KD accounted for 33% in the KD with coronary artery dilatation (CAD) group, compared with 46% in the KD without CAD group
Summary
KD has become the most common cause of acquired heart disease in children. Previous studies have well summarized the acute phase left ventricular (LV) systolic dysfunction using speckle tracking echocardiography (STE); changes in LV systolic function after long-term follow-up remain unclear. Kawasaki disease (KD) is an acute self-limited vasculitis that affects children, 85% of whom are < 5 years of age [1]. The incidence of KD has increased in the last three decades [2], making KD the most common cause of acquired heart disease in children [3]. The LV ejection fraction (LVEF) is the most commonly used conventional parameter to quantify global LV systolic function in children with KD; previous studies have usually demonstrated normal LVEF in the acute phase [5, 6].
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