Endothelial Function Evaluated by Flow-Mediated Dilatation in Pediatric Vascular Disease

Abstract

The endothelial function of children with and without vascular disease, consisting of 41 controls, 24 with Kawasaki disease (KD), and 46 with diabetes mellitus (DM), was examined. Age at examination ranged from 3 to 23 years (mean, 12.0 +/- 4.7). The flow-mediated dilatation (FMD) and intima-media complex in the common carotid artery were measured. In controls age at examination was not associated with FMD or intima-media complex. FMD significantly decreased in children with KD and DM compared with the control group (control vs KD or DM: 11.7 +/- 14.7 vs 3.0 +/- 11.0 or 6.4 +/- 8.5%, respectively; p < 0.05). However, there was no significant difference for intima-media complex among the groups. Furthermore, FMD in KD patients with coronary arterial aneurysm was lower than that in KD patients without aneurysm (-0.5 +/- 9.2 vs 8.3 +/- 9.1%, p < 0.05). In DM patients, FMD in the high HbA1c group (HbA1c = 7%) was lower than that in the normal HbA1c group (HbA1c < 7%) (4.8 +/- 8.1 vs 11.4 +/- 7.8%, p < 0.05). In conclusion, FMD detected endothelial impairment in children with KD or type 1 DM regardless of overt vascular complications, and FMD impairment occurs prior to intima-media complex thickening. By measuring both FMD and intima-media complex, useful information for predicting vascular complications may be obtained.

Coronary artery dilation among patients with paediatric-onset systemic lupus erythematosus

“…SLE is also considered a systemic inflammatory disease. Because these two systemic inflammatory disorders share common triggering agents, susceptibility, and immunopathogenic pathways in vascular inflammation (18)(19)(20)(21)(22)(23), the findings here may be the clinical manifestations of coronary arteritis in SLE, simulating Kawasaki disease (24). The risk of developing CAD is four to eight times higher in SLE patients than in healthy controls.…”

Pediatric Precursors of Adult Cardiovascular Disease: Noninvasive Assessment of Early Vascular Changes in Children and Adolescents

“…Investigators have assessed FMD in special populations of children such as those with type 1 diabetes, familial dyslipidemias, hypertension, Kawasaki's disease, and severe obesity. 9,11,[46][47][48][49][50] This body of research has confirmed that endothelial dysfunction is found in the childhood conditions that are known to predispose to early atherogenesis. Recently, investigations of endothelial function in children have revealed findings with clinical applicability for pediatric populations:…”

Endothelial dysfunction in adult patients with a history of Kawasaki disease

“…Hamaoka et al demonstrated that in patients with KD, coronary flow reserve was reduced in the coronary aneurysms and stenotic lesions [7]. Furthermore, other reports showed that systemic endothelial dysfunction occurred late after the onset of KD by measuring flow-mediated dilatation [5,9,11]. However, clinical evidence underlying the incidence of this endothelial dysfunction remains unclear at present.…”