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.
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Authors | Haiyong Wang, Jing Shang, Minghui Tong, Yan Song, Litao Ruan |
Journal | Clinical cardiology
(Clin Cardiol)
Vol. 42
Issue 8
Pg. 753-759
(Aug 2019)
ISSN: 1932-8737 [Electronic] United States |
PMID | 31173382
(Publication Type: Comparative Study, Journal Article)
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Copyright | © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. |
Chemical References |
- Immunoglobulins, Intravenous
- Immunologic Factors
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Topics |
- Child, Preschool
- Disease Progression
- Echocardiography
(methods)
- Female
- Follow-Up Studies
- Heart Ventricles
(diagnostic imaging, physiopathology)
- Humans
- Immunoglobulins, Intravenous
(therapeutic use)
- Immunologic Factors
(therapeutic use)
- Male
- Mucocutaneous Lymph Node Syndrome
(complications, diagnosis, drug therapy)
- Prognosis
- Retrospective Studies
- Systole
- Ventricular Dysfunction, Left
(diagnosis, etiology, physiopathology)
- Ventricular Function, Left
(physiology)
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