Application of Signal-Averaged Electrocardiogram to Myocardial Damage in the Late Stage of Kawasaki Disease

• Published in: Circulation Journal Vol. 70; no. 11; pp. 1443 - 1445
• Main Authors: Takeuchi, Makoto, Matsushita, Tohru, Kurotobi, Shunji, Sano, Tetsuya, Kogaki, Shigetoyo, Ozono, Keiichi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2006
• Subjects: Adolescent; Case-Control Studies; Child; Child, Preschool; Coronary Vessels - pathology; Coronary Vessels - physiopathology; Disease Progression; Electrocardiography - methods; Frequency domain analysis; Heart - physiopathology; Heart Diseases - etiology; Heart Diseases - physiopathology; Histopathological findings; Humans; Kawasaki disease; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - pathology; Mucocutaneous Lymph Node Syndrome - physiopathology; Myocardium - pathology; Prospective Studies; Signal Processing, Computer-Assisted; Signal-averaged electrocardiogram
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.70.1443

Background Myocardial damage occurs in the late stage of Kawasaki disease (KD) regardless of whether coronary artery lesions (CALs) are present. Methods and Results A signal-averaged electrocardiogram (ECG) was performed in 23 patients who were in the late stage of KD (CAL was found in 12 and no CAL (non-CAL) was found in 11) and 10 healthy controls. Filtered QRS duration and the root-mean-square voltage in the last 40 ms of the QRS complex were measured using time-domain analysis. Additionally, the area ratio (AR), (area of 20-50 Hz)/(area of 0-20 Hz) ×100, was calculated by frequency domain analysis. These findings were compared with the clinical data and histopathological findings. In time-domain analysis, there were no significant differences among the 3 groups. In frequency domain analysis, the AR in CAL was significantly higher than that in the other 2 groups. Furthermore, all 4 patients who underwent an endomyocardial biopsy showed a high AR and abnormal histopathological features. Conclusions The findings of the present study suggest that patients in the late stage of KD have abnormal findings on signal-averaged ECG even without stenotic lesions, arrhythmia or ischemia, a condition that might reflect histopathological changes in the myocardium in the late stage of KD. (Circ J 2006; 70: 1443 - 1445)