Echo-Doppler Assessment of Arterial Stiffness in Pediatric Patients with Kawasaki Disease

• Published in: Journal of the American Society of Echocardiography Vol. 26; no. 9; pp. 1084 - 1089
• Main Authors: AlHuzaimi, Abdullah, MD, Al Mashham, Yahya, MD, Potts, James E., PhD, De Souza, Astrid M., MSc, Sandor, George G.S., MB, ChB
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2013
• Subjects: Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiopathology; Cardiovascular; Child; Cohort Studies; Echocardiography Doppler; Echocardiography, Doppler - methods; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - diagnostic imaging; Mucocutaneous Lymph Node Syndrome - physiopathology; Pulse Wave Analysis; Pulse-wave velocity; Reference Values; Retrospective Studies; Sensitivity and Specificity; Vascular function; Vascular Stiffness - physiology; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; PP; TT; AOs; Shortening fraction; σps; Left ventricular mass index; LV; Peak aortic flow; Systolic blood pressure; Input impedance; EF; Diastolic blood pressure; AOflow; Mean velocity of circumferential fiber shortening; Systolic posterior wall thickness; PWV; CAL; Elastic pressure-strain modulus; AOcsa; PWd; Ejection fraction; Stress at peak systole; Transit time; Characteristic impedance; Left ventricular; Zc; Diastolic posterior wall thickness; End-systolic aortic dimension; Ep; Vascular function; PWs; Zi; Kawasaki disease; SF; BPd; Pulse-wave velocity; Pulse pressure; KD; LVESD; BPs; LVMi; Coronary artery lesion; Left ventricular end-systolic dimension; LVEDD; Left ventricular end-diastolic dimension; Echocardiography Doppler; MVCFc; Aortic annular cross-sectional area; AOd; End-diastolic aortic dimension
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2013.05.015

Background There is growing evidence to suggest increased arterial stiffness in patients with a history of Kawasaki disease (KD). Pulse-wave velocity (PWV) is the most validated measure of arterial stiffness. The aim of this study was to determine if aortic PWV is increased in children with KD. Methods This was a retrospective cohort study. The study cohort was composed of 42 patients with KD (mean age, 9.7 ± 2.0 years) and 44 age-matched control subjects. The primary measure was aortic PWV. Secondary measures included characteristic impedance (Zc), input impedance (Zi), elastic pressure-strain modulus (Ep), and β stiffness index and the following measures of left ventricular size and function: end-diastolic and end-systolic dimensions, wall thickness in diastole and systole, mass, shortening and ejection fractions, mean velocity of circumferential fiber shortening, and stress at peak systole. The appropriate measures were indexed to body surface area. The aortic stiffness and impedance indexes were derived using an echocardiography-Doppler method. Results Height, weight, body mass index, and body surface area were similar between the groups. PWV was higher in patients with KD compared with controls (495 vs 370 cm/sec, P  = .0008). Zc, Ep, and β stiffness index were higher in patients with KD, but the difference was not statistically significant. Left ventricular dimensions were all within normal limits, with no differences between the groups. Patients with KD had lower stress at peak systole compared with controls (55 vs 64 g/cm2 , P  = .01). There was a significant association between the length of time between the initial diagnosis and testing with PWV ( r  = 0.32, P  = .04) and Zi ( r  = −0.38, P  = .01) in patients with KD. There was no significant association between the arterial stiffness indexes (PWV, Zi, Zc, Ep, and β stiffness index) and length of fever, age at KD diagnosis, or heart rate. Logistic regression analysis revealed no association between coronary artery lesion classification and length of fever, day of illness at first treatment, age at KD diagnosis, or any of the arterial stiffness indexes. In the control group, there were significant associations between age and heart rate ( r  = −0.48, P  = .001), Zi ( r  = −0.55, P < .0001), Zc ( r  = −0.66, P < .0001), and β stiffness index ( r  = −0.31, P  = .04). There was an association between heart rate and Zc ( r  = 0.44, P  = .003) but no association between heart rate and PWV, Zi, Ep, or β stiffness index. Conclusions Arterial stiffness was increased in children with KD. There was no association between acute-phase KD coronary involvement and PWV. This implies that patients with KD may be at increased cardiovascular risk in the future.