Long-term evaluation of endothelial function in Kawasaki disease patients

Cardiol Young. 2013 Aug;23(4):517-22. doi: 10.1017/S1047951112001357. Epub 2012 Oct 8.

Abstract

Background: Kawasaki disease is an acute systemic vasculitis. Cardiac complications are frequent and include endothelial dysfunction in patients with coronary anomalies. So far, the presence of endothelial dysfunction in patients with no coronary lesions has not been demonstrated. Peripheral arterial tonometry (Endo-PAT) measures the microvascular function in response to local ischaemia and has been validated in adult population, but its use in children is scarce. Aim To evaluate endothelial dysfunction in children as a long-term complication after Kawasaki disease using Endo-PAT.

Methods: We evaluated two groups of subjects: (1) Kawasaki disease patients over 11 years of age, diagnosed for >5 years, with no coronary lesions, or any other risk factors for cardiovascular disease; (2) control group of individuals without cardiovascular risk factors. Patients and controls were clinically accessed. Endo-PAT was performed to determine reactive hyperaemia index and augmentation index.

Results: A total of 35 individuals (21 males, age 21 ± 6 years) were evaluated (group 1: 19; controls: 16). Kawasaki disease patients presented significant lower reactive hyperaemia index (1.68 ± 0.49 versus 2.31 ± 0.53; p = 0.001). Augmentation index was similar in both groups (-10 ± 7 versus -11 ± 5; p > 0.005). Most patients with Kawasaki disease disclosed endothelial dysfunction (68%) compared with only 12% in controls.

Conclusions: Endo-PAT is feasible and reproducible in the child population. Endothelial dysfunction is a frequent long-term complication in patients after Kawasaki disease with normal appearing coronary arteries. However, these results need validation in a larger population.

MeSH terms

  • Adolescent
  • Adult
  • Case-Control Studies
  • Endothelium, Vascular / physiopathology*
  • Female
  • Humans
  • Hyperemia / physiopathology
  • Male
  • Manometry
  • Microvessels / physiopathology*
  • Mucocutaneous Lymph Node Syndrome / physiopathology*
  • Pulse Wave Analysis
  • Young Adult