Subclinical Myocardial Dysfunction Post Kawasaki Disease: A Systematic Review and Meta-Analysis

Kawasaki disease (KD) is an acute childhood vasculitis with well-recognized coronary involvement, but subtle long-term myocardial dysfunction may persist despite preserved conventional systolic indices. Two-dimensional speckle-tracking echocardiography enables sensitive assessment of left ventricular global longitudinal strain (GLS).

A systematic review and meta-analysis were conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, and Google Scholar were searched for studies evaluating post-acute GLS in children or adolescents with prior KD compared with healthy controls. The outcome measure was the mean difference (MD) in GLS (KD minus control). Random-effects models were used for the primary analysis.

Four case-control studies involving 192 patients with prior KD and 138 healthy controls were included in the quantitative synthesis. Compared with controls, patients with prior KD had significantly less negative GLS values, indicating worse longitudinal deformation (pooled MD, 0.77%; 95% CI, 0.18 to 1.36; Z = 2.34; p = 0.019). Between-study heterogeneity was low (Q = 3.17, I² = 5.3%, tau² = 0.030). Leave-one-out analysis showed that the overall direction of effect remained positive, although confidence intervals widened when individual studies were omitted. Interpretation of the funnel plot was limited by the small number of studies.

Children and adolescents with a history of KD demonstrate a modest but significant reduction in LV GLS during follow-up, consistent with persistent subclinical myocardial dysfunction. Speckle-tracking echocardiography may provide incremental value in the long-term cardiac assessment of selected patients with prior KD.