Evaluation of left ventricular function in immunoglobulin-resistant children with Kawasaki disease: a two-dimensional speckle tracking echocardiography study

Clin Cardiol. 2019 Aug;42(8):753-759. doi: 10.1002/clc.23213. Epub 2019 Jun 7.

Abstract

Background: Kawasaki disease (KD) patients who are unresponsive to intravenous immune globulin (IVIG) have a high occurrence of coronary artery lesions (CALs). The characteristics of left ventricular (LV) function alternation in IVIG-resistant patients are not well-described.

Hypothesis: Two-dimensional speckle tracking echocardiography (STE) is a useful technique that can accurately detect myocardium subclinical dysfunction in resistant patients and may assist in differentiating patients with KD at a higher risk of IVIG resistance.

Methods: A consecutive sample of 50 IVIG-resistant patients (25 males, 2.2 ± 0.9 years), 50 IVIG-responsive patients (27 males, 2.2 ± 0.7 years) and 50 normal subjects (27 males, 2.1 ± 0.9 years) were analyzed using STE, and receiver operating characteristic curve (ROC) analysis was utilized to determine the threshold values of STE parameters associated with IVIG resistance.

Results: Compared with normal children, IVIG-resistant patients had lower global longitudinal strain (GLS) (15.82 ± 3.32 vs 20.01 ± 2.98, P = 0.000) and lower global circumferential strain (GCS) (16.65 ± 3.12 vs 20.11 ± 2.86, P = 0.042). Both GLS and GCS in IVIG-resistant patients were significantly lower than in IVIG-responsive patients (15.82 ± 3.32 vs 19.95 ± 3.01, 16.65 ± 3.12 vs 19.01 ± 3.00, P = .000, .030, respectively). ROC analysis demonstrated that the absolute values of GLS < 16.8% and GCS < 15.9% were optimal predictors of IVIG unresponsiveness (area under the curve = 0.78, 0.75; sensitivity = 0.83, 0.79; specificity = 0.69, 0.65, respectively).

Conclusion: IVIG-resistant patients presented with more severe LV systolic dysfunction compared with IVIG-responsive patients, which may be the result of myocarditis rather than CALs. STE may be a helpful diagnostic tool that provides supportive criteria to detect KD patients at a higher risk of IVIG resistance.

Keywords: Kawasaki disease; intravenous immune globulin resistance; left ventricular function; two-dimensional speckle tracking echocardiography.

Publication types

  • Comparative Study

MeSH terms

  • Child, Preschool
  • Disease Progression
  • Echocardiography / methods*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunologic Factors / therapeutic use
  • Male
  • Mucocutaneous Lymph Node Syndrome / complications
  • Mucocutaneous Lymph Node Syndrome / diagnosis
  • Mucocutaneous Lymph Node Syndrome / drug therapy*
  • Prognosis
  • Retrospective Studies
  • Systole
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / physiology*

Substances

  • Immunoglobulins, Intravenous
  • Immunologic Factors