Orthostatic and Exercise Effects in Children Years After Kawasaki Disease
Yoshihiro Nakamura1,2, Takehiro Hama3,4, Yoshie Nakamura5
1Department of Pediatrics, Yatsu Hoken Hospital, 4-6-16, Yatsu, Narashino City, Chiba, 275-0026, Japan. yonakamura-tky@umin.ac.jp.
Insights
Children years after Kawasaki disease (KD) show altered heart rate and blood pressure responses during exercise and upon standing, suggesting potential long-term vascular effects. These subclinical impacts on vascular tonus may affect cardiovascular health long after the initial illness.
Area of Science:
- Pediatrics
- Cardiovascular Physiology
- Exercise Science
Background:
- Kawasaki disease (KD) is a pediatric illness that can affect blood vessels.
- Long-term cardiovascular effects of KD in children, particularly without coronary arterial aneurysms, are not well understood.
- Assessing hemodynamic responses during and after exercise can reveal subclinical cardiovascular changes.
Purpose of the Study:
- To investigate the long-term orthostatic and exercise hemodynamic effects in children years after Kawasaki disease (KD).
- To compare heart rate (HR) and blood pressure (BP) responses during treadmill exercise tests (TMET) between children with and without a history of KD.
- To identify potential subclinical impacts on vascular tonus in children post-KD.
Main Methods:
- A case-control study comparing 60 children with a history of KD (mean age 9.8 years, 6.6 years post-KD) to 60 matched controls without KD.
- Treadmill exercise tests (TMET) were used to record heart rate (HR) and blood pressures (BPs).
- Orthostatic responses, exercise tolerance, and HR recovery post-exercise were analyzed and compared between groups.
Main Results:
- No significant difference in exercise tolerance was observed between the KD and non-KD groups.
- Children with a history of KD exhibited an 8.6% faster heart rate (HR) upon standing compared to controls (P < 0.01), indicating potentially weaker orthostatic vasoconstriction.
- The KD group showed a faster HR recovery 5 minutes post-exercise (P < 0.05) and a higher incidence of pulse pressure augmentation during exercise stages.
- HR and BP during exercise stages were not significantly different between groups.
Conclusions:
- Children years after Kawasaki disease, even without coronary arterial aneurysms, may experience long-term subclinical hemodynamic alterations.
- Findings suggest potential impacts on vascular tonus, evidenced by altered orthostatic responses and heart rate recovery.
- These subclinical changes highlight the importance of continued cardiovascular monitoring in children post-KD.
Abstract:
The long-term orthostatic and/or exercise hemodynamic effects in children years after Kawasaki disease (KD) were studied using clinical data from the treadmill exercise test (TMET). Heart rate (HR) and blood pressures (BPs) recorded in TMET were compared between two age, gender, and body scale-matched groups of patients with and without a history of KD. The KD group included 60 patients (9.8 ± 2.7 years old) 6.6 ± 2.6 years after KD without coronary arterial aneurysm. The non-KD group included 60 children (10.2 ± 2.7 years old) with other diagnoses. The exercise tolerance in TMET was not statistically different between the two groups. The KD group had a faster HR on standing than the non-KD group by 8.6% (101.5 ± 12.2 vs. 93.5 ± 15.9 bpm, respectively; P < 0.01), suggesting weaker and/or retarded orthostatic vasoconstriction. The pulse pressure was largely augmented above the 4th stage beyond 160 mmHg in 10.6 versus 0% (5 vs. 0) of the KD and non-KD groups (P < 0.05), respectively, while HR and BPs were not significantly different through exercise stages between the two groups. The KD group also showed a faster HR recovery five minutes after exercise than the non-KD group, by 5.7% (108.0 ± 11.6 vs. 102.2 ± 14.2 bpm, respectively; P < 0.05). Our results might indicate long-term subclinical impacts on the vascular tonus of children years after the disease that have not been recognized in previous studies.
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