Abnormal myocardial work in children with Kawasaki disease
Jolanda Sabatino1,2, Nunzia Borrelli3,4, Alain Fraisse3,4
1Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. jolesbt@hotmail.it.
Insights
Myocardial work index (MWI) effectively detects subtle cardiac abnormalities in children with Kawasaki disease (KD), even when standard tests appear normal. This non-invasive method aids in identifying early myocardial dysfunction in KD patients, regardless of coronary artery dilatation.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Research
Background:
- Kawasaki disease (KD) poses risks of coronary artery aneurysms and myocardial dysfunction.
- Subtle myocardial abnormalities may exist in KD patients despite normal ejection fraction and strain.
- Non-invasive myocardial work assessment offers a potential tool for early detection of cardiac issues.
Purpose of the Study:
- To evaluate the diagnostic performance of non-invasive myocardial work in identifying myocardial abnormalities in children with KD and coronary dilatation (CADL).
- To assess if myocardial work parameters can detect subtle cardiac dysfunction independent of coronary artery status.
Main Methods:
- Echocardiography was used to assess left ventricular (LV) systolic function and global longitudinal strain (GLS) in 100 children.
- Global myocardial work index (MWI), constructive work (MCW), and wasted work (MWW) were calculated from LV pressure-strain loops.
- Patients included: 45 KD with CADL, 45 controls, and 10 KD without CADL.
Main Results:
- Children with KD and CADL showed significantly reduced MWI, MCW, and MWE compared to controls, despite normal LV systolic function and GLS.
- MWI was also reduced in KD patients without CADL compared to controls.
- Reduced MWI, MCW, and MWE were observed in KD children even with normal LVEF and GLS, suggesting abnormalities independent of CADL.
Conclusions:
- Non-invasive myocardial work assessment, particularly MWI, is a sensitive indicator of subclinical myocardial dysfunction in children with KD.
- These myocardial abnormalities appear to be independent of coronary artery dilatation.
- Myocardial work parameters may offer valuable insights into cardiac health in KD patients beyond conventional echocardiographic measures.
Abstract:
Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.
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