Elevation of the index of left ventricular mass during the acute and subacute phase of Kawasaki disease, and its association with indexes of diastolic function

Abstract

Our aim was to determine whether the index of left ventricular mass increases during the acute and subacute phase of Kawasaki disease, and to investigate any relationship between this index and clinical and echocardiographic variables. We performed, therefore, a retrospective study of 66 children with Kawasaki disease, having a mean age of 2.85 years, comparing the findings with those obtained from 57 normal controls, having a mean age of 2.99 years. The data from the patients used for comparison was obtained during the acute and subacute phase of the illness, as well as during the phase of convalescence. We performed correlation analysis of the findings during the acute and subacute phase, determining the relationship between the index of left ventricular mass and other variables. The index was higher (p = 0.0461), and the velocity of propagation of left ventricular early diastolic flow was lower (p < 0.0001), during the acute and subacute phase when compared to control values. The index then reduced (p = 0.0001) during the phase of convalescent when compared to the acute and subacute phase. Levels of albumin in the serum (p = 0.0193), peak E velocity (p = 0.0479), and velocity of propagation (p = 0.0360) were found to be related to the index of left ventricular mass. Significant relationships were found between the differences in this index and differences in body weight when findings during the acute and subacute phase were compared to those of the phase of convalescence. The index of left ventricular mass, therefore, is increased during the acute and subacute phase of Kawasaki disease, and is associated with altered diastolic indexes. This elevation may be due to generalized myocardial swelling from acute inflammation and increased vascular permeability. Measuring this index as a potential predictor of diastolic function should be added to studies of cardiac function during the acute and subacute phase of Kawasaki disease.

Ventricular Repolarisation During Exercise Challenge Occurring Late After Kawasaki Disease

“…Spatial myocardial electrical heterogeneity has been well described in arrhythmogenic conditions with abnormal QTd [2]. It is likely that anomalous QTd after KD could be the result of myocardial inflammation [35,41], similar to what is observed in other immune-induced myocarditis [39], but further investigation is necessary to verify that hypothesis.…”

Diagnosis of incomplete Kawasaki disease

“…Additional diagnostically helpful findings are inflammation at the Bacille Calmette-Guérin inoculation site32), anterior uveitis10,18), elevated levels of brain natriuretic peptide (BNP)33-36) and N-terminal pro-BNP37), hyponatremia22), elevation of the left ventricular mass38), and diastolic dysfunction of the left ventricle35,39). The diagnostic validities of these clinical, laboratory, and echocardiographic findings should also be tested in the future.…”

Log-transformed plasma level of brain natriuretic peptide during the acute phase of Kawasaki disease is quantitatively associated with myocardial dysfunction

“…We previously showed that serum albumin concentration and left ventricular mass index were significantly associated during the acute phase of Kawasaki disease, which suggests that increases in left ventricular mass index may result from myocardial swelling caused by increased vascular permeability17). Increases in left ventricular mass have been significantly associated with diastolic dysfunctions17). Thus, our findings that log-BNP was significantly associated with serum albumin concentration and left ventricular mass index, indicate a causative association between increases in left ventricular mass caused by myocardial swelling and myocardial systolic/diastolic dysfunction that induces secretion of BNP from the myocardium.…”

“…Increased vascular permeability from vasculitis and resultant vascular leakage are key features of the pathophysiology of Kawasaki disease, and increased vascular leakage may cause hypoalbuminemia and tissue edema15). We previously showed that serum albumin concentration and left ventricular mass index were significantly associated during the acute phase of Kawasaki disease, which suggests that increases in left ventricular mass index may result from myocardial swelling caused by increased vascular permeability17). Increases in left ventricular mass have been significantly associated with diastolic dysfunctions17).…”

“…Whatever the mechanism of left ventricular hypertrophy, we speculate that it may be a cause of myocardial dysfunction, which induced the increased secretion of BNP. Already we showed the association between an increased left ventricular mass and the myocardial systolic/diastolic dysfunction in the acute phase of Kawasaki disease9,17).…”