Abnormal myocardial work in children with Kawasaki disease

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.

Prediction of Significant Coronary Artery Disease Through Advanced Echocardiography: Role of Non-invasive Myocardial Work

“…As a matter of fact, peak strain is determined by the afterload concurrently with contraction, while numerically equal peak segmental strain values are not associated to the same level of segmental systolic function in early vs. mid-systole, reflecting the impact exerted by a higher afterload in mid-systole. Our results extend and complement previous findings ( 7 , 8 , 43 ). In our study, global PSI had a direct correlation with global MWW but an inverse correlation with global MWE.…”

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

“…Myocardial work has been measured invasively and used as a marker of ventricular contractility for decades ( 8 – 10 ). Russell et al have introduced a novel method for calculating non-invasive MW ( 11 , 12 ), which takes into consideration speckle-tracking analysis and LV pressure estimated from brachial artery cuff pressure and good reproducibility ( 13 ).…”

“…A recent study from our group evaluated the diagnostic performance of non-invasive MW indices in a cohort of children and adolescents with Kawasaki disease (KD) with and without coronary dilatation ( 12 ). It was thus demonstrated that non-invasive MW indices are reduced in children with KD, even in the absence of coronary aneurysm, and that they can detect subtle myocardial abnormalities better than GLS and LV EF.…”

“…In this regard, accounting for multiple hemodynamic factors, MW indices have been shown to provide a more accurate estimation of systolic function compared with the strain measurements alone ( 12 ).…”

Echocardiographic Reference Ranges of Non-Invasive Myocardial Work Indices in Newborns

“…After entering peripheral systolic (SBP) and diastolic blood pressure (DBP) values, the software calculated the constructive and wasted work. By aggregating the segmental values for the constructive and wasted work, the software calculated the global con-sitive indicator is highly effective in detecting cardiac dysfunction in various childhood and newborn cardiac diseases, including Kawasaki disease 12 and preterm birth. 13 The reference range for MCW data has been reported to vary with age.…”