Sanchez Aura A, Sexson Tejtel Sara K, Almeida-Jones Myriam E, Feagin Douglas K, Altman Carolyn A, Pignatelli Ricardo H
Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
Congenit Heart Dis. 2019 Nov;14(6):1024-1031. doi: 10.1111/chd.12787. Epub 2019 May 17.
Children with Kawasaki disease (KD) with persistent coronary artery aneurysms (CAAs) can develop chronic vasculopathy and subsequent myocardial ischemia. Early detection of this process is challenging. Myocardial deformation analysis can detect early alterations in myocardial performance. We aim to determine whether there are differences in myocardial deformation between KD patients with and without CAAs.
This is a cross-sectional study of 123 echocardiograms performed on 103 children with KD. Myocardial deformation was measured with two-dimensional speckle tracking (2DSTE). The echocardiograms were divided into groups according to the KD phase in which they were performed: acute, subacute, and convalescent/chronic. The convalescent/chronic phase group was then divided based on the presence or absence of CAAs. Left ventricular (LV) global longitudinal strain (GLS), global longitudinal strain rate (GLSSR), global circumferential strain (GCS), global circumferential systolic strain rate (GCSSR), peak torsion, and torsion rate were measured.
The numbers of echocardiograms analyzed in each of the KD phase groups were: 31 acute, 25 subacute, and 67 convalescent/chronic. Myocardial deformation was within normal limits in all groups. However, GLSSR, GCSSR, peak torsion, and torsion rate were lower in the convalescent/chronic phase group than in the acute phase group (mean, -1.37 ± 0.24 vs -1.55 ± 0.21 1/s; -1.63 ± 0.27 vs -1.84 ± 0.35 1/s; 2.49 ± 1.13 vs 3.41 ± 2.60 °/cm, and 21.97 ± 8.36 vs 26.69 ± 10.86 °/cm/s; P < .05 for all). The convalescent/chronic phase subgroup with CAAs had lower GLSSR and GCSSR than the subgroup without CAAs (mean, -1.23 ± 0.22 vs -1.42 ± 0.22 1/s; -1.46 ± 0.25 vs -1.68 ± 0.26 1/s, P < .05 for both).
Children in the convalescent/chronic phase of KD have a subtle decrease in strain rate when compared to the acute phase, although within the normal range. This decrease is more pronounced in children with CAAs than those without CAAs. Longitudinal studies are needed to discern whether low-normal strain rate predicts decreased myocardial function in the long term.
患有持续性冠状动脉瘤（CAA）的川崎病（KD）患儿可发展为慢性血管病变及随后的心肌缺血。早期检测这一过程具有挑战性。心肌变形分析可检测心肌功能的早期改变。我们旨在确定有无CAA的KD患者在心肌变形方面是否存在差异。
这是一项对103例KD患儿进行的123次超声心动图检查的横断面研究。采用二维斑点追踪（2DSTE）测量心肌变形。超声心动图根据其检查时的KD阶段分为：急性期、亚急性期和恢复期/慢性期。然后根据有无CAA对恢复期/慢性期组进行划分。测量左心室（LV）整体纵向应变（GLS）、整体纵向应变率（GLSSR）、整体圆周应变（GCS）、整体圆周收缩期应变率（GCSSR）、峰值扭转和扭转率。
各KD阶段组分析的超声心动图数量分别为：急性期31例、亚急性期25例和恢复期/慢性期67例。所有组的心肌变形均在正常范围内。然而，恢复期/慢性期组的GLSSR、GCSSR、峰值扭转和扭转率低于急性期组（平均值分别为，-1.37±0.24对-1.55±0.21 1/s；-1.63±0.27对-1.84±0.35 1/s；2.49±1.13对3.41±2.60°/cm，以及21.97±8.36对26.69±10.86°/cm/s；所有P<0.05）。有CAA的恢复期/慢性期亚组的GLSSR和GCSSR低于无CAA的亚组（平均值分别为，-1.23±0.22对-1.42±0.22 1/s；-1.46±0.25对-1.68±0.26 1/s，两者P<0.05）。
KD恢复期/慢性期的患儿与急性期相比，应变率虽在正常范围内但有轻微下降。这种下降在有CAA的患儿中比无CAA的患儿更明显。需要进行纵向研究以确定低正常应变率是否能长期预测心肌功能下降。
