Long-term impaired exercise capacity and oxygen consumption in Kawasaki disease patients

Kawasaki disease (KD) is a systemic inflammatory condition, likely triggered by a respiratory infection, inducing myocardial inflammation, and complicated with coronary aneurysms. The objectives are to measure the late cardiopulmonary exercise response and associate the severity of the acute episode with the long-term aerobic capacity. Data on the acute KD episode were collected retrospectively. Children and adolescents with past KD underwent standardized ergometer cardiopulmonary exercise testing. Regression analysis was used to associate coronary Z-scores and acute biomarkers, including maximum N-terminal pro-B-type natriuretic peptide (NT-proBNP), with the exercise parameters. Of 43 patients diagnosed with KD (mean age 4.97 ± 2.88 years, 42% females), 30 were age-and-sex matched after a mean of 6.78 ± 3.00 years (range 1.5-16 years) with 15 controls. Peak oxygen consumption (peakVO₂) and ventilatory threshold were significantly decreased in KD patients (34.1 ± 11.1 versus 39.4 ± 7.2 mL·kg⁻¹·min⁻¹, p = 0.025, and 50.7 ± 13.7 versus 56.3 ± 11.8%, p = 0.036, respectively). Acute NT-proBNP and acute coronary Z-score were not associated with peakVO₂ (odds ratio OR [95% confidence interval] 0.974 [0.734-1.293] and 1.023 [0.719-1.455], respectively). Instead, peakVO₂ in KD patients with a persistent coronary aneurysm, defined by a coronary segment lumen greater than 1.5-fold that of the adjacent segment, was lower than controls (26.2 ± 6.4 versus 39.4 ± 7.2 mL·kg⁻¹·min⁻¹, p = 0.013).

Children with KD had reduced aerobic capacity 7 years after the diagnosis. Maximum acute NT-proBNP and acute coronary Z-score were not associated with the late impaired exercise capacity, but persistent coronary aneurysms were.

• Acute coronary Z-score and blood NT-proBNP are markers of disease severity in Kawasaki disease. • Kawasaki disease is associated with late coronary ischaemic complications.

• In Kawasaki disease patients, several years after the diagnosis, peak exercise mass-related oxygen consumption and ventilatory threshold are decreased, and body mass index is increased. • Persistent coronary aneurysms, but neither acute coronary Z-score nor acute maximum NT-proBNP, are associated with the late impaired exercise capacity.