Inflammatory reaction in the acute phase of Kawasaki disease may better predict chronic cardiac dysfunction than coronary artery lesions

Abstract

Background: Kawasaki disease (KD) is a pediatric acute vasculitis affecting the coronary arteries and cardiac tissues. Research has been conducted on the assessment of acute cardiac function in KD; however, chronic cardiac dysfunction remains understudied, particularly in terms of coronary artery lesion (CAL) grading and acute-phase inflammatory markers. This study aimed to assess the effect of CAL grading on chronic cardiac function in KD patients, and explore the association between CAL grading and acute-phase inflammatory markers.

Methods: A prospective study was conducted on 25 children with giant coronary aneurysms (GCAs) and gender-, height-, and weight-matched subgroups. Chronic cardiac function and inflammatory markers were assessed using echocardiography and laboratory tests.

Results: The KD group showed significantly impaired left ventricular function compared to the healthy control group, including reduced global longitudinal strain (19.94%±3.42% vs. 21.27%±1.69%, P=0.001) and circumferential strain (20.85%±4.01% vs. 23.14%±5.37%, P=0.002). Most systolic/diastolic parameters demonstrated similar statistical significance (KD vs. healthy control group, all P<0.05). Notably, no association was found between CAL severity gradation and cardiac dysfunction (P>0.05 across CAL subgroups). Surprisingly, a considerable proportion of patients with GCAs (61.11%) and medium-sized coronary artery aneurysms (69.57%) had normalized cardiac function. Acute-phase C-reactive protein levels emerged as a predictor for chronic cardiac dysfunction (cut-off value: 127.79 mg/L).

Conclusions: Chronic cardiac dysfunction in KD patients is affected by CAL grading and acute-phase inflammatory markers. Integrating inflammatory indicators into CAL risk stratification could enhance clinical management strategies. Further research with larger cohorts needs to be conducted to validate these findings and establish longitudinal monitoring protocols.

Keywords: Kawasaki disease (KD); chronic follow-up; global longitudinal strain (GLS); left heart function in sequelae stage.

Figure 1

Study’s research flowchart. AHA, American Heart Association; CT, computed tomography; GCAs, giant coronary aneurysms; GLS, global longitudinal strain; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; MCAs, medium coronary aneurysms; SCA, small coronary aneurysm.

Figure 2

ROC curve illustrating the capacity of CRP to predict GLS <18%. This analysis yielded a cut-off value of 127.79 mg/L. The AUC reached 0.702 (95% confidence interval: 0.51–0.89), indicating moderate predictive performance. It had a sensitivity of 0.60 and a specificity of 0.849. AUC, area under the curve; CI, confidence interval; CRP, C-reactive protein; GLS, global longitudinal strain; ROC, receiver operating characteristic.

Figure 3

Correlation between acute-phase indicators and chronic-phase cardiac function in children with KD. KD, Kawasaki disease; MV-GCS, mitral valve plane global circumferential strain; MV-SRe, mitral valve plane systolic strain rate; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammation index.