Cardiopulmonary Function, Exercise Capacity, and Echocardiography Finding of Pediatric Patients With Kawasaki Disease

Abstract

Coronary artery (CA) abnormalities influence exercise capacity (EC) of patients with Kawasaki disease (KD), and Z-score of CA is a well established method for detecting CA aneurysm. We studied the influence of KD on cardiopulmonary function and EC; meanwhile we analyzed echocardiographic findings of KD patients. We also assessed the correlation between CA Z-score and EC of KD patients to see if CA Z-score of KD patients could reflect EC during exercise.Sixty-three KD patients were recruited as KD group 1 from children (aged 5–18 y) who received transthoracic echocardiographic examinations and symptom-limited treadmill exercise test for regular follow-up of KD from January 2010 to October 2014 in 1 medical center. We then divided KD group 1 into KD group 2 (<5 y, n = 12) and KD group 3 (≥5 y, n = 51) according to time interval between KD onset to when patients received test. Control groups were matched by age, sex, and body mass index. Max-Z of CA was defined as the maximal Z-score of the proximal LCA or RCA by Dalliarre equation or Fuse calculator.All routine parameters measured during standard exercise test were similar between KD and control groups, except that peak rate pressure products (PRPPs) in KD group 1 to 3 were all lower than corresponding control groups significantly (P = 0.010, 0.020, and 0.049, respectively). PRPPs correlated with Max-Z of CA by both equations modest inversely (by Dallaire, P = 0.017, Spearman rho = −0.301; by Fuse, P = 0.014, Spearman rho = −0.309).Our study recruited larger number of KD patients and provided a newer data of EC of KD patients. Our finding suggests that after acute stage of KD, patients could maintain normal cardiorespiratory fitness. Therefore, we believe that it is important to promote cardiovascular health to KD patients and KD patients should exercise as normal peers. However, since KD patients might still have compromised coronary perfusion during exercise, it remains crucial to assess and monitor cardiovascular risk of KD patients. Max-Z of CA correlates with PRPP modest inversely and might be used as a follow-up indicator of CA reserve during exercise after acute stage of KD.

Patients with Kawasaki Disease Have Significantly Low Aerobic Metabolism Capacity and Peak Exercise Load Capacity during Adolescence

“…Scholars have discovered that although children with KD have lower rates of myocardial perfusion while they are exercising, their cardiopulmonary function and exercise load capacities do not significantly differ from those of healthy children [ 1 , 2 ]. However, some studies have reported that children with KD have lower weekly moderate-to-vigorous activity (MVPA) than healthy children and lower exercise self-efficacy evaluations [ 3 ].…”

Myocardial fibrosis after adrenergic stimulation as a long-term sequela in a mouse model of Kawasaki disease vasculitis

“…While most studies report improvement of myocardial function with treatment, there is now growing evidence that ongoing myocardial abnormalities occur in the long term (24). It has recently been shown that children suffering from subclinical myocardial complications during acute KD display long-term cardiovascular complications, such as lower myocardial flow reserve and higher total coronary resistance (33)(34)(35). However, few studies have considered a potential link between myocarditis in childhood KD and long-term persistent damage to the myocardium, including myocardial remodeling and fibrosis (30,36).…”

Arterial stiffness late after Kawasaki disease in children: Assessment by performing brachial–ankle pulse wave velocity

“…Tuan et al reported KD patients with/without CALs in chronic stage might still have compromised coronary perfusion during exercise. 22 The correlation of the baPWV and VO 2 peak may partially explain their finding. 22 Regular measurement of baPWV is useful to evaluate the degree of early atherosclerosis and cardiac dysfunction in KD patients.…”

“…A previous study by Tuan et al showed that KD patients with/without CALs in chronic stage might still have compromised coronary perfusion during exercise, which was related to the Z score of the coronary artery. 22 The long-term effect of these subclinical vascular changes on cardiovascular function is still unclear and merits further evaluation. The purpose of this study is to examine the arterial stiffness using baPWV and exercise performance of KD patients in chronic stage.…”