Quantitative evaluation of myocardial fibrosis by cardiac integrated backscatter analysis in Kawasaki disease

Abstract

Background: Kawasaki disease is an acute, systemic vasculitis that affects the coronary arteries. However, the relationship between myocardial fibrosis and Kawasaki disease has been completely unknown until now. We aimed to provide quantitative information about myocardial fibrosis using cardiac integrated backscatter in Han race Kawasaki disease patients. Methods: Ninety Kawasaki disease patients and 90 healthy control subjects were recruited. Based on Kawasaki disease status, the patients were categorized into 3 groups: acute, subacute, and convalescence phase. Based on coronary artery status, the Kawasaki disease patients were categorized into 3 groups: without coronary artery lesions, with coronary artery dilation, and with coronary artery aneurysms. All subjects underwent two-dimensional and Doppler examinations to measure clinical echocardiographic parameters. Myocardial fibrosis was detected with calibrated integrated backscatter imaging. Results: Left ventricle systolic functions were normal in both the Kawasaki disease and control participants. The myocardial calibrated integrated backscatter values of the left ventricles of the acute (p < 0.001), subacute (p < 0.001) and convalescence phase (p < 0.001) Kawasaki disease patients were significantly greater than those of the healthy controls. The left ventricle myocardial calibrated integrated backscatter values were significantly smaller in the Kawasaki disease patients without coronary artery lesions than in the Kawasaki disease patients with coronary artery dilations and coronary artery aneurysms in different phases. The left ventricle myocardial calibrated integrated backscatter results were positively correlated with coronary artery status in the acute (r = 0.331, p < 0.001), subacute (r = 0.456, p < 0.001) and convalescence phases (r = 0.407, p < 0.001) of Kawasaki disease. Conclusion: Our findings may suggest that myocardial fibrosis occurs during early episodes of Kawasaki disease given uncertainties that exist regarding correlations of calibrated integrated backscatter and myocardial fibrosis.

Effect of pirfenidone on cardiac complications in a model of Kawasaki disease in female Balb/C Mice: Histological and Immunohistochemical study

“…Inflammatory cells were also observed between cardiac myocytes [2,11] that was suggestive of myocarditis which is considered as a feature of KD [9.11,13,27,28] . Myocardial fibrosis was also observed in this study in Mallory stained sections [9,11,12] . This fibrosis was explained by authors who reported that it might be due to previous ischemia in the area perfused by the affected coronary artery [9,11] .…”

“…Myocardial ischemia remains an important concern. Some authors reported that patients with KD might be at risk of developing ischemic cardiomyopathy due to abnormal myocardial perfusion and reduced coronary flow [12] .…”

“…Their results suggested that cellular infiltration in the ventricular myocardium develops in the acute phase of KD and persists for a long time. They also noticed absence of myocardial fibrosis in patients of KD with normal coronary arteries [11,12] . It was also reported that endothelial abnormalities and intimal proliferation may lead to cardiac ischemia with subsequent myocardial infarction [13] .…”

“…Cardiovascular sequel of untreated KD in young adults include myocardial ischemia, infarction, arrhythmia, congestive heart failure, sudden death [3,7,8] and also valvular lesions [9] . The most important and serious lesions in KD are coronary artery lesions [1,3,6,10,11,12] which can cause coronary artery aneurysms or stenosis [6,12] . Coronary artery aneurysm is a serious complication of KD and develop in 5% of treated and 30% of untreated patients [1,7,10] .…”

Kawasaki disease – experience of Pediatric University Hospital, Sofia, Bulgaria, 1993–2014. Part II: cardiovascular manifestations and treatment

“…We suppose that the reduced ejection fraction is due to subclinical myocardial fibrosis. According to some authors, myocardial fibrosis is related to previous ischemia in the area perfused by the coronary artery where an aneurysm has been present or as a sequel of myocarditis in the acute phase of the disease [33,34].…”