Moghadam Ehsan Aghaei, Taraz Maryam, Zeinaloo Aliakbar, Majnoon Mohammad Taghi, Zanjani Keyhan Sayadpour, Gorgi Mojtaba
Cardiology Division, Pediatric Department, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, No. 346, Keshavarz Blvd, Tehran, 14188, Iran.
Egypt Heart J. 2024 May 19;76(1):58. doi: 10.1186/s43044-024-00491-5.
Kawasaki disease is an acute febrile vasculitis of childhood mainly affecting children under 4 years of age. In the acute stage of the disease, heart function decreases and gradually returns to normal after treatment. However, subendocardial involvement may persist, which cannot be assessed by M-mode echocardiography. Strain echocardiography is a recently developed technique to assess subendocardial involvement of myocardial deformation. We aimed to study the stratified strain of left ventricular function in a Kawasaki patient at least 6 months after the acute stage of the disease with special conditions for entering the study using two-dimensional speckle-tracking imaging. Between September 2020 and October 2022, 27 healthy children and 27 children with a history of Kawasaki disease more than 6 months ago were evaluated using two-dimensional global longitudinal peak systolic strain with automated function imaging technology.
The mean age of patients was 5.6 years. With M-mode echocardiography, ejection fraction of each group was in the normal range. Mean (± standard deviation) global longitudinal peak strain in four-chamber view of girls with Kawasaki disease was - 23.74 ± 2.77, and that in boys with Kawasaki disease was - 20.93 ± 2.06 (P value = 0.008). GLPS (global longitudinal peak strain) was compared as an overall average and as in a separate segment, which showed significant difference in two comparisons. In our study, a decrease in the function of some cardiac segments is reported. Global longitudinal peak strain in four-chamber view was significantly lower in boys. Comparing different segments, a difference in global left ventricular long-axis strain was found between the two groups. On the other hand, there was a major difference between the two groups in the basal inferolateral, basal anterolateral, and mid-inferolateral, which receives blood from Left Circumflex artery.
Using stain echocardiography to detect continued subendocardial involvement in asymptomatic children with a history of Kawasaki disease for a better understanding of the condition, effective management and follow-up is recommended.
川崎病是一种儿童急性发热性血管炎，主要影响4岁以下儿童。在疾病急性期，心脏功能下降，治疗后逐渐恢复正常。然而，心内膜下受累可能持续存在，M型超声心动图无法评估。应变超声心动图是一种最近开发的评估心肌变形心内膜下受累情况的技术。我们旨在使用二维斑点追踪成像技术，研究疾病急性期后至少6个月的川崎病患者左心室功能的分层应变，并设定了进入研究的特殊条件。2020年9月至2022年10月期间，使用自动功能成像技术对27名健康儿童和27名6个月前有川崎病病史的儿童进行了二维整体纵向峰值收缩应变评估。
患者的平均年龄为5.6岁。通过M型超声心动图检查，每组的射血分数均在正常范围内。川崎病女孩四腔心切面的平均（±标准差）整体纵向峰值应变为-23.74±2.77，川崎病男孩为-20.93±2.06（P值=0.008）。将整体纵向峰值应变（GLPS）作为总体平均值和单独节段进行比较，在两项比较中均显示出显著差异。在我们的研究中，报告了一些心脏节段功能下降。男孩四腔心切面的整体纵向峰值应变显著较低。比较不同节段，发现两组之间左心室整体长轴应变存在差异。另一方面，两组在接受左旋支供血的基底下外侧、基底前外侧和中间下外侧节段存在主要差异。
建议使用应变超声心动图检测有川崎病病史的无症状儿童的心内膜下持续受累情况，以便更好地了解病情、进行有效管理和随访。
