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The Assessment of Diastolic and Systolic Function in Kawasaki Disease Using Myocardial Strain Imaging and Tissue
Yan He1,2,3, Qirui Zheng2,3,4, Chunlu Jing2,3,5
1Post Graduate School of Jinzhou Medical University, Jinzhou, China.
Insights
Kawasaki disease (KD) impacts heart function, showing reduced global longitudinal strain (GLS) and global circumferential strain (GCS), alongside lower early diastolic mitral annular velocity (e') and impaired left atrial reservoir strain (LASr). These findings highlight selective cardiac abnormalities in KD patients.
Area of Science:
- Cardiology
- Pediatric Rheumatology
- Diagnostic Imaging
Background:
- Kawasaki disease (KD) is an acute febrile vasculitis affecting children.
- KD can lead to myocardial dysfunction, impacting cardiac systolic and diastolic function.
- Early detection of cardiac involvement is crucial for managing potential long-term complications.
Purpose of the Study:
- To evaluate the impact of Kawasaki disease on myocardial systolic and diastolic function.
- To utilize myocardial strain imaging and tissue Doppler imaging (TDI) for comprehensive assessment.
- To identify specific cardiac function markers affected by KD.
Main Methods:
- Conducted a systematic literature review of studies assessing cardiac function in KD patients.
- Analyzed markers including global longitudinal strain (GLS), global circumferential strain (GCS), early diastolic mitral annular velocity (e'), and left atrial reservoir strain (LASr).
- Performed meta-analysis using standardized mean differences (SMD) and confidence intervals (CIs), including subgroup and sensitivity analyses.
Main Results:
- Included 34 studies with 1821 KD patients and 1157 healthy controls.
- KD patients exhibited significantly reduced GLS and GCS, lower e', and impaired LASr compared to controls.
- Subgroup analyses in younger children (age ≤ 5 years) and males (≥50% proportion) revealed similar patterns of reduced GLS, GCS, and LASr.
Conclusions:
- Kawasaki disease is associated with selective myocardial abnormalities, including impaired systolic function (reduced GLS and GCS) and diastolic dysfunction (lower e', impaired LASr).
- Markers like E/e', global radial strain (GRS), and left atrial volume index (LAVI) did not show significant overall differences.
- Myocardial strain imaging and TDI are valuable tools for detecting subtle cardiac impairments in KD.
Background:
Kawasaki disease (KD) is an acute febrile vasculitis that may lead to myocardial dysfunction despite its self-limiting nature. This study aimed to evaluate the impact of KD on systolic and diastolic function using myocardial strain imaging and tissue Doppler imaging (TDI).
Methods:
A comprehensive literature review was conducted using electronic databases, including studies assessing systolic and diastolic function markers in KD patients. These markers included global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), early diastolic mitral annular velocity (e'), ratio of mitral valve velocity and mitral annular velocity in early diastole (E/e'), left atrial reservoir strain (LASr), and left atrial volume index (LAVI). Standardized mean differences (SMD) and corresponding 95% confidence intervals (CIs) were pooled in overall and subgroup analyses. Additionally, publication bias, trim and fill analysis, sensitivity analysis including leave-one-out influence analysis, and meta-regression were performed.
Results:
Thirty-four studies involving 1821 KD patients and 1157 healthy controls (HCs) were included. KD patients showed significantly reduced (less negative) |GLS| (SMD = 0.98, 95% CI: 0.63 to 1.33, p < 0.001) and |GCS|(SMD = 0.37, 95% CI: 0.09 to 0.66, p = 0.010), as well as lower e' (SMD = -0.21, 95% CI: -0.41 to -0.00, p = 0.046) and reduced LASr (SMD = -1.51, 95% CI: -2.56 to -0.47, p = 0.005). Subgroups of age ≤ 5 years continued to show reduced (less negative) |GLS| and |GCS|, lower LASr, and higher E/e' (p < 0.05). Similarly, subgroups with a male proportion ≥50% also demonstrated reduced (less negative) |GLS| and |GCS| and lower LASr (p < 0.05). No significant differences were found in E/e', GRS, and LAVI (all p > 0.05).
Conclusion:
KD is associated with reduced (|GLS| and |GCS|), lower e' velocity, and impaired LASr, while E/e', GRS, and LAVI show no significant overall differences. These findings indicate selective abnormalities detected by myocardial strain imaging and TDI rather than uniform systolic and diastolic impairment, with subgroup results interpreted as exploratory.
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