Division of Cardiology, Department of Pediatrics, Primary Children's Medical Center and the University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT, USA.
Eur Heart J Cardiovasc Imaging. 2013 Nov;14(11):1061-8. doi: 10.1093/ehjci/jet041. Epub 2013 Mar 20.
We sought to determine whether velocity vector imaging (VVI)-derived left ventricular (LV) myocardial deformation indices could detect subtle myocardial abnormalities in acute Kawasaki disease (KD).
The study cohort of children with KD was divided by coronary artery dilation (CAD, Z-score >2.5) and/or uncomplicated vs. treatment-resistant (persistent/recrudescent fever) cases and compared with age-matched controls. Peak systolic LV myocardial strain (ε) and strain rate (SR) were obtained using VVI on pre-treatment echocardiograms. Comparisons were made between controls and (i) the entire KD group, (ii) KD group subdivided by CAD, and (iii) KD group subdivided by treatment resistance. The KD group consisted of 32 children (66% male, 24 ± 20 months). Of these, 17 had CAD and 14 had resistant KD. The control group consisted of 22 children (55% male, 20 ± 17 months). Routine echo indices of LV systolic function were normal for both groups. Compared with controls, KD patients had lower global longitudinal ε (-15.29 vs. -12.94, P = 0.04) and SR (-1.12 vs. -0.87, P = 0.003). On subgroup analysis compared with controls, KD patients with CAD (n = 17) had lower longitudinal ε (-15.29 vs. -11.87, P = 0.02) and SR (-1.12 vs. -0.86, P = 0.005). Subdivided by treatment resistance, compared with controls, those with resistant KD had lower longitudinal ε (-15.29 vs. -11.8, P = 0.01) and SR (-1.12 vs. -0.82, P = 0.003).
Despite normal LV systolic function by routine echocardiographic measurements, KD patients have reduced longitudinal LV ε and SR, which may be more sensitive indicators of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD.
我们旨在确定速度向量成像（VVI）衍生的左心室（LV）心肌变形指数是否可以检测急性川崎病（KD）中的细微心肌异常。
KD 患儿的研究队列根据冠状动脉扩张（CAD，Z 评分>2.5）和/或是否并发治疗抵抗（持续性/复发性发热）进行分组，并与年龄匹配的对照组进行比较。使用 VVI 在治疗前的超声心动图上获得峰值收缩期 LV 心肌应变（ε）和应变率（SR）。在对照组和（i）整个 KD 组、（ii）根据 CAD 分组的 KD 组和（iii）根据治疗抵抗性分组的 KD 组之间进行了比较。KD 组包括 32 名儿童（66%为男性，24±20 个月）。其中 17 名患有 CAD，14 名患有治疗抵抗性 KD。对照组包括 22 名儿童（55%为男性，20±17 个月）。两组的 LV 收缩功能常规超声心动图指标均正常。与对照组相比，KD 患者的整体纵向 ε（-15.29 对-12.94，P=0.04）和 SR（-1.12 对-0.87，P=0.003）较低。与对照组相比，在 CAD 亚组分析中，KD 患者（n=17）的纵向 ε（-15.29 对-11.87，P=0.02）和 SR（-1.12 对-0.86，P=0.005）较低。根据治疗抵抗性进行细分，与对照组相比，治疗抵抗性 KD 患者的纵向 ε（-15.29 对-11.8，P=0.01）和 SR（-1.12 对-0.82，P=0.003）较低。
尽管常规超声心动图测量显示 LV 收缩功能正常，但 KD 患者的纵向 LV ε 和 SR 降低，这可能是心肌炎症更敏感的指标，并可为避免 KD 延迟诊断提供支持性标准。
