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. 2021 Apr 12;11(1):7974.
doi: 10.1038/s41598-021-86933-5.

Abnormal myocardial work in children with Kawasaki disease

Jolanda Sabatino  1   2 , Nunzia Borrelli  3   4 , Alain Fraisse  3   4 , Jethro Herberg  3   4 , Elena Karagadova  3   4 , Martina Avesani  3   4 , Valentina Bucciarelli  3   4 , Manjit Josen  3   4 , Josefa Paredes  3   4 , Enrico Piccinelli  3   4 , Maraisa Spada  3   4 , Sylvia Krupickova  3   4 , Ciro Indolfi  5 , Giovanni Di Salvo  6   7
Affiliations

Abnormal myocardial work in children with Kawasaki disease

Jolanda Sabatino et al. Sci Rep. .

Abstract

Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The figure shows that LV ejection fraction measured either by echocardiogram (A) or CMR (B) did not differ significantly in children with Kawasaki disease compared to CTRLs. Global longitudinal strain values were within the normal range both in the KD/CADL and in the KD group and comparable to CTRLs (C). Graphs in this figure were drawn by using Past software (version 4.02). CMR cardiovascular magnetic resonance, KD Kawasaki disease, CTRLs controls.
Figure 2
Figure 2
The graphs show global MWI (A), MCW (B) and MWE (C) significantly reduced in children belonging to the KD/CADL group compared to controls. Likewise, KD group shows lower MWI values compared with CTRL. Graphs in this figure were drawn by using Past software (version 4.02). MWI myocardial work index, MCW myocardial constructive work, MWE myocardial wasted work.
Figure 3
Figure 3
The figure shows an example of the pressure strain loops and the integrated area.
Figure 4
Figure 4
KD/CADL patients with normal GLS presented significant differences in MWI values compared to controls. Graphs in this figure were drawn by using Past software (version 4.02).
See this image and copyright information in PMC

References

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