The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi'an Jiaotong University, No 277, Yanta West Road, Xi'an, 710061, Shaanxi Province, China.
The Third Department of Ultrasound Medicine, The Second Affiliated Hospital, Lanzhou University, Lanzhou, Gansu Province, China.
Int J Cardiovasc Imaging. 2020 Oct;36(10):1941-1951. doi: 10.1007/s10554-020-01909-2. Epub 2020 Jun 11.
The left ventricular (LV) systolic dyssynchrony index (SDI) is an important prognostic indicator for many cardiovascular diseases; however, the characteristics of the SDI in patients with Kawasaki disease (KD) are unknown. In this study, we aimed to identify and quantify the SDI using real-time three-dimensional echocardiography (RT3DE) in KD patients during different phases. In addition, we intended to explore whether the SDI is associated with systolic dysfunction. Seventy consecutive KD patients and seventy age- and sex-matched controls were enrolled. The SDIs (percent of cardiac cycle) of 16 segments (16-SDI%) and 12 segments (12-SDI%) were calculated based on the defined standard deviation of each segment time from end diastole to the minimal systolic volume according to the 17-segment model (apex excluded). In the acute phase, the 16-SDI% and 12-SDI% were significantly higher in KD patients than in controls (4.40 ± 0.14 vs. 1.98 ± 0.12, P = 0.000; 3.55 ± 1.21 vs. 1.67 ± 0.93, P = 0.009, respectively), and patients with coronary artery aneurysm (CAA) exhibited higher 16-SDI% (P = 0.021) and 12-SDI% (P = 0.034) than patients without CAA. In the convalescent phase, patients with CAA still had higher 16-SDI% (P = 0.002) and 12-SDI% (P = 0.031) than controls, while the SDI in patients without CAA recovered to normal. The 16-SDI% was negatively correlated with the LV ejection fraction obtained from RT3DE (r = - 0.845, P = 0.000). Mechanical dyssynchrony is prevalent in KD patients during the acute phase and transient in patients without CAA, while patients with CAA still have impaired synchrony even in the convalescent phase. LV systolic dysfunction is associated with increased dyssynchrony. RT3DE is a valuable modality for identifying and quantifying dyssynchrony in KD patients.
左心室（LV）收缩不同步指数（SDI）是许多心血管疾病的重要预后指标；然而，川崎病（KD）患者的 SDI 特征尚不清楚。在这项研究中，我们旨在使用实时三维超声心动图（RT3DE）在 KD 患者的不同阶段识别和量化 SDI。此外，我们还旨在探讨 SDI 是否与收缩功能障碍有关。连续纳入 70 例 KD 患者和 70 例年龄和性别匹配的对照组。根据 17 节段模型（排除心尖），根据舒张末期至最小收缩容积的每个节段时间的标准偏差计算 16 节段（16-SDI%）和 12 节段（12-SDI%）的 SDI（%心动周期）。在急性期，KD 患者的 16-SDI%和 12-SDI%明显高于对照组（4.40±0.14 比 1.98±0.12，P=0.000；3.55±1.21 比 1.67±0.93，P=0.009），并且伴有冠状动脉瘤（CAA）的患者 16-SDI%（P=0.021）和 12-SDI%（P=0.034）高于无 CAA 的患者。在恢复期，伴有 CAA 的患者 16-SDI%（P=0.002）和 12-SDI%（P=0.031）仍高于对照组，而无 CAA 的患者 SDI 恢复正常。16-SDI%与 RT3DE 获得的 LV 射血分数呈负相关（r=-0.845，P=0.000）。急性期 KD 患者存在机械不同步，且无 CAA 的患者呈一过性，而伴有 CAA 的患者即使在恢复期仍存在不同步。LV 收缩功能障碍与不同步增加有关。RT3DE 是识别和量化 KD 患者不同步的一种有价值的方法。
