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Published on: April 25, 2014
Serial evaluation of myocardial function using the myocardial performance index in Kawasaki disease
Eun Song Song1, Somy Yoon2, Joo Hyun Cho1
1Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 501-757, South Korea.
Insights
Transient left ventricular dysfunction is common in children with Kawasaki disease (KD), impacting both complete and incomplete forms. Myocardial performance indices effectively assess this dysfunction, especially in those with coronary artery lesions.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Systemic Vasculitis
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children, characterized by systemic vasculitis.
- Myocarditis is a frequent complication of KD, potentially leading to left ventricular (LV) dysfunction.
- Early detection and management of LV dysfunction are crucial for improving outcomes in KD patients.
Purpose of the Study:
- To evaluate left ventricular (LV) dysfunction in pediatric patients with Kawasaki disease (KD).
- To assess the utility of myocardial performance index (MPI) measured by pulse Doppler (PD) and tissue Doppler imaging (TDI) in characterizing LV dysfunction during acute and convalescent phases of KD.
- To investigate the correlation between LV dysfunction and coronary artery lesions (CALs) in KD patients.
Main Methods:
- Retrospective analysis of 89 children diagnosed with KD between January 2010 and August 2012.
- Assessment of LV ejection fraction, PD-MPI, and TDI-MPI at diagnosis and at 2, 14, and 56 days post-intravenous immunoglobulin (IVIG) treatment.
- Comparison with 70 healthy children serving as a control group, and analysis of KD patients with and without coronary artery lesions (CALs).
Main Results:
- Patients with KD exhibited lower LV ejection fraction and higher LV TDI-MPI at diagnosis compared to controls.
- Elevated LV TDI-MPI persisted up to 2 days post-IVIG treatment in KD patients.
- KD patients with CALs at diagnosis showed significantly higher septal TDI-MPI, indicating more prominent LV dysfunction.
Conclusions:
- Transient LV dysfunction is observed in both complete and incomplete Kawasaki disease during the acute phase.
- Left ventricular dysfunction is more pronounced in KD patients with coronary artery lesions at diagnosis.
- Pulse Doppler (PD) and tissue Doppler imaging (TDI) derived myocardial performance indices (MPI) are valuable tools for assessing LV function in pediatric KD patients.
Background:
Kawasaki disease (KD) is known as systemic vasculitis, and more than half of the patients with KD have myocarditis, which can induce ventricular dysfunction. In this study, we evaluate left ventricular (LV) dysfunction in patients with KD based on the myocardial performance index (MPI) using pulse Doppler (PD) and tissue Doppler imaging (TDI), from the acute to convalescent phases.
Methods:
We retrospectively studied 89 children diagnosed with KD from January 2010 to August 2012. We assessed the presence of coronary artery lesions (CALs) and the LV ejection fraction, PD-MPI, and TDI-MPI at diagnosis, and 2, 14, and 56 days after intravenous immunoglobulin (IVIG) treatment. We enrolled 70 healthy children as a control group.
Results:
The ejection fraction in patients with KD at diagnosis (67.3 ± 0.9%) was lower than that in the control group (69.8 ± 0.8%, P = 0.035), and the LV TDI-MPIs for patients with KD at diagnosis (0.49 ± 0.01) and 2 days after IVIG treatment (0.48 ± 0.01) were higher than those in the control group (0.45 ± 0.01, P = 0.002, P = 0.033, respectively). No significant differences were found in the LV dysfunction between the patients with complete and incomplete KD. Septal TDI-MPIs in patients with KD with CAL at diagnosis (0.52 ± 0.02) were higher than those in patients with KD without CAL (0.47 ± 0.01, P = 0.019).
Conclusions:
Transient LV dysfunction occurred in patients with complete and incomplete KD in the acute stage. In patients with KD with CAL at diagnosis, the LV dysfunction was more prominent. The PD-MPI and TDI-MPI are useful parameters for assessing LV function in patients with KD.
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