Abnormal Tissue Doppler Images are Associated With Elevated Plasma Brain Natriuretic Peptide and Increased Oxidative Stress in Acute Kawasaki Disease

Abstract

awasaki disease (KD) is a systemic vasculitis that primarily affects small and medium-sized arteries. 1 Transient myocardial dysfunction in children with acute KD has been reported 2,3 and moreover, myocardial inflammation, including myocarditis and microvascular damage in the myocardium, has been shown to cause aberrations in cardiac function. 4 Several recent studies have discussed the usefulness of tissue Doppler imaging (TDI) to evaluate left ventricular (LV) function. [5][6][7][8][9][10][11][12][13][14] Tissue Doppler measurement of myocardial Doppler velocity can be used to measure long-axis functions, which seem to be both more sensitive to minor disturbances in LV function and relatively preload-independent. 11,[13][14] In the present study we used TDI to evaluate disturbance of myocardial function in acute KD patients. Circulation Journal Vol.71, March 2007The plasma brain natriuretic peptide (BNP) level is associated with cardiac function in adult patients with congestive heart failure. 15,16 Although elevation of BNP has been reported in acute KD patients,17 no relation between BNP and cardiac function has been found.Reports have suggested that increased systemic oxidative stress is associated with progression of cardiovascular disease, including ischemia -reperfusion injury, atherosclerosis, and heart failure. [18][19][20][21][22][23][24] The isoprostanes are a complex family of compounds produced from arachidonic acid via a free radical-catalyzed mechanism. 18,19 The level of 8-isoprostane is used as a pathophysiological marker of lipid peroxidation. We previously reported elevation of urinary 8-isoprostane levels in acute KD patients, 25 and although the exact pathological role of increased oxidative stress in acute KD is uncertain, we believe that it is associated with oxidative injury to systemic vessels. 25 We hypothesize that this combined with disturbance of myocardial microcirculation may contribute to myocardial dysfunction in acute KD. Therefore, the purpose of the present study was to investigate the relationship between abnormal myocardial performance and plasma BNP levels, and to investigate the association between abnormal myocardial performance and enhanced oxidative stress. Background The aims of this study were to evaluate myocardial mechanics using pulsed tissue Doppler imaging (TDI), and to determine the relationship between abnormal myocardial performance and plasma brain natriuretic peptide (BNP) levels and oxidative stress in acute Kawasaki disease (KD). Methods and ResultsConsecutive TDI parameters, including peak systolic velocity (Sw) and early (Ew) and late diastolic excursion of the mitral annuli were obtained in 42 patients with KD (mean age: 2.4±0.4 years) in weeks 1, 2, and 3, and during convalescence. Plasma BNP level and urinary 8-isoprostane were also examined during the acute phase. These data were then compared with TDI profiles from 62 healthy children, plasma BNP levels in 38 controls with other febrile illnesses, and urinary 8-isoprostane levels in 13 healthy chi...

Tissue Doppler Imaging as a Predictor of Immunoglobulin Resistance in Kawasaki Disease

“…[10] demonstrated that children with KD had left ventricular diastolic dysfunction that was associated with elevated brain natriuretic peptide. Takeuchi et al also found that left ventricular dysfunction was associated with elevated brain natriuretic peptide and that the left ventricular dysfunction improved during the convalescent phase; however, they did not find any difference in the diastolic parameters between nonresponders and IVIG responders [25]. Our study differed from Takeuchi et al study because we had larger sample size and were able to demonstrate the difference in diastolic parameters between the resistant and responder groups.…”

“…TDI has been shown to be abnormal in patients with KD in the acute and convalescent phases [1,25]. However, differences in myocardial velocities from TDI between IVIG responders and IVIG resistant children with KD have not been well investigated.…”

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

“…Subsequent studies of myocardial characterization and function have reported variable findings. [298][299][300] Long-term myocardial dysfunction, resulting from primary myocardial insult at the time of acute KD and which is independent of long-term coronary artery abnormalities, may very rarely occur, although evidence-based reports are few. Whether the myocarditis that occurs with the acute illness leads to long-term myocardial pathology, such as fibrosis and myocyte dropout, independent of coronary artery abnormalities is not clear.…”

Diastolic function in children with Kawasaki Disease

“…Abnormalities of left ventricular contractility and systolic function have been documented to resolve within 12 months of onset of KD, with rapid improvement after the administration of intravenous immunoglobulin (IVIG) [1][2][3]. Recent studies have reported left ventricular diastolic dysfunction in KD patients during the acute phase based on the inflow Doppler and tissue Doppler profiles of the left ventricle [11,12]. These reports concluded that diastolic dysfunction might contribute to the increased brain natriuretic peptide (BNP) levels seen in these patients [13].…”