| Part Ⅰ:The application of two-dimensional speckle tracking imaging to evaluate the longitudinal systolic strain of left ventricle in children with Kawasaki diseaseObjective:To measure the changes of left ventricular global longitudinal peak systolic strain(GLPS)in different course of KD by 2DSTI,and to analyze its relation with coronary artery lesion,mitral regurgitation and pericardial effusion.And by evaluating the correlation with laboratory indicators,to explore the value of 2DSTI in the accurate assessment of left ventricular dysfunction in different phases of KD.Method:A total of 101 children hospitalized for acute KD were enrolled,and 50 normal children matched for age and gender were included as controls.According to the echocardiography,101 patients with acute KD were divided into:23 cases of CAL group and 78 cases of nCAL group;26 cases of MR group and 75 cases of nMR group;12 cases of PE group and 89 cases of nPE group.The analysis software tracks myocardial motion and obtain four chamber,long axis and two chamber of the left ventricular myocardium and average GLPS.The changes of GLPS in each group of left ventricle in acute phase were analyzed,and the correlation between GLPS and laboratory indicators was analyzed.The left ventricular strain data of the acute,subacute and recovery phases of KD children were collected,and the changes of left ventricular GLPS in different phase of KD were analyzed and compared with the normal control group.Results:(1)GLPS was significantly reduced in children with acute KD,acute LVPS-A4C(p<0.001),GLPS-LAX(p<0.001),GLPS-Avg(p<0.001),and GLPS-A2C(p)<0.05)were lower than the normal control group,and there was a statistically significant difference,while there was no significant difference between the LVEF and LVFS groups.In the subacute phase,all GLPS in children with KD gradually increased.GLPS-A4C(p<0.01),GLPS-LAX(p<0.05),and GLPS-Avg(p<0.001)were significantly increased compared with the acute phase,and the differences were statistically significant.During the recovery phase,all left ventricular systolic strains were not significantly different from the normal control group.(2)Acute subgroup analysis:Left ventricular GLPS-LAX(p<0.01),GLPS-A2C(p=0.01),and GLPS-Avg(p<0.01)were significantly lower in the MR group,and there were significant differences compared with nMR group;GLPS-LAX,GLPS-A4C,GLPS-A2C and GLPS-Avg were not significantly different in CAL group,nCAL group,PE group and nPE group.(3)In acute KD,AST,ALT,ESR,CRP and Hb were significantly different between CAL group and nCAL group(p<0.05),while left ventricular GLPS-Avg was significantly associated with elevated CRP and decreased Hb.Conclusion:(1)2DSTI assessment of left ventricular GLPS can reflect the contractility of left ventricular myocardium early and sensitively,and can assess changes of myocardial contractility in different KD phases.Left ventricular GLPS is a convenient,reproducible indicator for non-invasive assessment of left ventricular systole functional,and is worth of clinical application.(2)There was no significant correlation between myocarditis and coronary artery injury in acute KD,but it was associated with the presence of cardiac MR,elevated CRP and decreased Hb,which indicating acute KD,indicating acute cardiac function and myocardial inflammatory injury.Related to myocardial ischemia caused by coronary lesions.PartⅡ:The application of two-dimensional speckle tracking imaging to evaluate the early carotid artery elastic function of Kawasaki diseaseObjective:Using carotid artery circumferential peak strain(CCS)and the carotid artery intima-media thickness(CIMT)measured by 2DSTI to evaluate the changes of carotid vascular morphology and elastic function in acute KD,and to analyze their relevance with KD coronary lesions,IVIG resistance and laboratory parameters.To explore the feasibility and value of CCS and CIMT for the assessment of vascular function in acute KD.Method:From January 2017 to December 2017,97 patients with KD were diagnosed in our hospital(KD group).According to echocardiography,there were 27 patients with coronary artery lesions(CAL group)and 60 patients with coronary artery injury(nCAL group);According to the effect of IVIG treatment,there were 85 cases in the IVIG response group and 12 cases in the IVIG resistance group.At the same time,18 fever patients caused by infection(fever control group)and 24 healthy children(normal control group)were selected.2DSTI was used to measure CCS,CIMT and carotid artery contraction rate(CAR)in acute phase KD;Laboratory indicators were also collected to analyze whether CCS,CIMT and CAR were different between KD group,fever control group and normal control group,and to analyze the difference between coronary artery damage and IVIG resistance subgroup.The correlation between CCS,CIMT and the laboratory indicators was analyzed.Results:(1)CCS was significantly lower in the KD group than in the fever group and the normal control group(p=0.001).There was no significant difference in CCS between the fever group and the normal control group.CAR was significantly decreased in both KD group and fever group.There was significant difference between the two groups and the normal control group(p<0.005),while the decrease of CAR in the KD group was more obvious than that in the fever group,but the difference between the two groups was not statistically significant.CIMT,CADd showed no significant difference between these three groups.(2)CCS was significantly lower in the CAL group than in the nCAL group.There was a statistically significant difference between these two groups(p<0.001).CCS was significantly lower in the CAL group than in the normal control group(p<0.001).CIMT was significantly higher in the CAL group than in the nCAL group(p<0.05),and the difference was statistically significant compared with the normal control group(p<0.05).CAR decreased in the CAL group and the nCALgroup,and was statistically different from the normal control group.(3)CCS was significantly lower in the IVIG resistance group than in the IVIG response group.There was a statistically significant difference between these two groups(p=0.001).There was no significant difference of CIMT between these two groups.Serum CRP(p=0.030)and WBC(p=0.021)were significantly higher in the IVIG resistance group,and the difference was statistically significant compared with the IVIG response group.CIMT,CADd,and CAR had a decreasing trend in the CAL group,but no statistically significant differences were observed.(4)Correlation analysis:CCS was weakly correlated with CAR(r=0.278,P=0.001),and was weakly negatively correlated with serum CRP and ALT(r=-0.419,P=0.001 and r=-0.305,P=0.003).CIMT was not significantly associated with CAR and laboratory indicators.Conclusion:(1)CCS measured by 2DSTI can evaluate the acute carotid elasticity function of KD,which is more sensitive than CIMT.(2)CCS has a good correlation with coronary artery damage and IVIG resistance,which indicates that it can reflect the severity of KD in acute KD,can indicate the probability of coronary lesion early.(3)CCS is a non-invasive,convenient ultrasound indicator for KD’s early assessment of coronary and peripheral vascular function. |
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