Evaluation of Myocardial function using Tissue

Evaluation of Myocardial function using Tissue Doppler Imaging during the follow-up of patients with Kawasaki disease C.E. Tacke (1), T.W. Kuijpers (1), M. Groenink (2), N.A. Blom (3), I.M. Kuipers (3) (1) Department of pediatric immunology, hematology and infectious diseases, Emma Children’s Hospital, Academic Medical Center, Amsterdam (2) Department of Radiology and Cardiology, Academic Medical Center, Amsterdam (3) Department of pediatric cardiology, Emma Children’s Hospital, Academic Medical Center, Amsterdam

INTRODUCTION Kawasaki disease (KD) is an acute pediatric vasculitis that is associated with the development of coronary artery aneurysms (CAAs). Myocarditis is another well-known cardiac manifestation. Although histopathological studies suggest persistent myocardial abnormalities after KD, the long-term effects on cardiac function remain to be revealed.The aim of this study was to evaluate left ventricular (LV) function during KD follow-up using Tissue Doppler Imaging (TDI), and to compare the results with healthy controls. METHODS

Patients with a history of KD (aged 4 – 18 years) were included. All subjects underwent 2-dimensional transthoracic echocardiography at least 6 months after the disease onset. The examination assessed LV systolic performance (fractional shortening) and diastolic performance (Doppler flow over the mitral valve). Additionally, peak velocities of systolic (S), early diastolic (E), and late diastolic (A) motion of the lateral wall (LW) and intraventricular septum (IVS) were measured using TDI in apical 4-chamber view. For control subjects the same measurements were performed.

RESULTS

Ninety patients (mean age 11.4 ± 4.1 years, 68% male) and 63 controls (mean age 10.5 ± 4.1 years, 57% male) were included. The mean interval from KD onset to echocardiography was 7.8 ± 4.6 years. The LV parameters are given in Table 1.

CONCLUSION

This is the first study evaluating LV function using TDI during the long-term follow-up of patients with KD. LV function did not differ significantly between patients and controls, except for systolic and early diastolic func-

Table 1. LV parameters in patients with history of KD (n=90) and controls (n=63) Patients

Controls

p-value*

Fractional shortening (%)

36 ± 5

36 ± 5

.621

TDI LW S’ (cm/s)

7.6 ± 1.8

8.7 ± 2.6

.007

TDI IVS S’ (cm/s)

7.6 ± 1.0

7.6 ± 1.0

.638

MV E velocity (m/s)

0.95 ± 0.15

0.97 ± 0.17

.415

MV A velocity (m/s)

0.48 ± 0.11

0.48 ± 0.10

.637

MV E/A ratio

2.09 ± 0.51

2.10 ± 0.52

.956

TDI LW E’ (cm/s)

17.1 ± 2.6

18.3 ± 3.2

.012

TDI LW A’ (cm/s)

5.9 ± 1.1

5.9 ± 1.5

.911

TDI LW E/E’

5.7 ± 1.2

5.4 ± 1.3

.182

TDI IVS E’ (cm/s)

13.4 ± 1.8

13.7 ± 2.1

.324

TDI IVS A’ (cm/s)

5.7 ± 1.0

5.7 ± 1.5

.890

TDI IVS E/E’

7.1 ± 1.3

7.1 ± 1.4

.893

tioning of the lateral

Systolic

wall. This needs further investigation, including the influence of CAAs.

Diastolic

* Differences between patients and controls were analysed using independent sample t-tests.

110 Abstracts ingediend voor het Amsterdam Kindersymposium 2013