The Study In The Evaluation Of Left Ventricular Function In Patients With Kawasaki Disease By Two Dimensional Speckle Tracking Imaging

Objective 1)To assess the change of left ventricular myocardial systolic function in kawasaki disease(KD)patients during different phases by two-dimensional speckle tracking imaging(2DSTI)and analyze the relationship between systolic peak strain(S)and strain rate(SR)of left ventricle and other indices.2)Analyse the change of left ventricular function in coronary artery dilation subgroup and intravenous immunoglobulin(IVIG)resistances subgroup in acute phase.3)To assess whether myocardial dysfunction detected by 2DSTI can predict IVIG resistance using receiver operating characteristic(ROC).Methods 80 KD children were enrolled in acute phase from January 2015 to October 2016 in our hospital,and at the same time 50 age and gender-matched children who underwent echocardiography for murmur evaluation and were found to have no cardiac abnormalities were included as control group.The study cohort were divided into coronary artery dilation subgroup(Z>2.5)and IVIG treatment-resistant(persistent/recrudescent fever)subgroup,and the subgroups were compared with controls.Peak systolic left ventricular myocardial S and SR were obtained using 2DSTI before IVIG in the acute phase,1st week after IVIG in the subacute phase,and 8th week after the onset of KD in the convalescent phase.Comparisons were made between controls and(i)the entire KD group in different phases,(ii)KD group subdivided by CAD in acute phase,and(iii)KD group subdivided by treatment resistance in acute phase.We also analyzed the results of entire KD group during different phases and the relationship between left ventricular systolic S,SR and other indexes.Results Patients population The entire KD group consisted of 80 children(69% male,24±20 months).Of these KD patients,20 patients had CAD and 18 patients had IVIG resistant.The control group consisted of 50 children(59% male,20±17 months).Echocardiographic findings 1)Conventional echocardiogram analysis of entire group during different phases:Compared with controls,The entire KD group had higher left ventricular Tei index,left ventricular mass(LVM),left ventricular mass index(LVMI),E/Em,left coronary artery(LCA)diameter,right coronary artery(RCA)diameter and left anterior descending artery(LAD)diameter in acute phase(P<0.05)and still higher indices in LVMI,LCA diameter,E/Em in subacute phase(P<0.05),but all indices recovered to normal in convalescent phase.The left ventricular Tei index,LVM and LVMI of entire KD group in subacute phase decreased significantly compared with acute phase.2)Analysis of the 2DSTI results in entire KD group:Compared with controls,The entire KD patients had lower peak systolic global longitudinal strain(GLS),basal longitudinal S,middle longitudinal S,peak systolic global circumferential strain(GCS)and apical circumferential S(P<0.05)in acute phase and lower GLS and middle longitudinal S(P<0.05)in subacute phase.All indices recovered to normal in convalescent phase.The GLS,basal longitudinal S,GCS and apical circumferential S of entire KD group in subacute phase increased significantly compared with acute phase(P<0.05).3)Analysis of correlation between systolic left ventricular S,systolic left ventricular SR and other indices:The GLS was associated with E/Em,LVMI,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),white blood cell(WBC)and alanine transaminase(ALT)negatively(r=-0.66,-0.61,-0.59,-0.67,-0.64,-0.69 respectively P < 0.05)in acute phase.No association of left ventricular systolic S and SR were found with CAD and other indices in this phase.4)Subgroup analysis of 2DSTI results:Compared with controls,KD patients with CAD had lower GLS,global longitudinal strain rate(GLSR),basal longitudinal S,basal longitudinal SR,mid longitudinal S(P<0.05).KD patients with CAD had higher ESR,CRP,ALT,AST than normal cornary artery group(P<0.05).Compared with controls,KD patients with IVIG resistant in acute phase had higher indices in left ventricular Tei index,E/Em and LVMI(P<0.05)and lower indices in GLS,GLSR,basal longitudinal S,apical longitudinal S,basal longitudinal SR and apical longitudinal SR(P<0.05).Compared with IVIG responder subgroup,IVIG resistant group had higher left ventricular Tei index,E/Em,album(ALB),ESR,CRP,ALT,platelet(PLT)and lower value in GLS,basal longitudinal S.ROC analysis demonstrated that left ventricular systolic GLS<16.8 was a good predictor of IVIG unresponsiveness(AUC = 0.79,sensitivity 0.762,specificity 0.627).Conclusions Despite normal left ventricular systolic function by routine echocardiographic measurements in acute phase,KD patients have had reduced left ventricular systolic S which may be more sensitive indicator of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD.The myocardium fucntion in IVIG resssitant group may have more serious damage degree,and the CAD may not be a risk factor in increasing left ventricular dysfunction in acute phase.The new technology may provide clinician with valuable information on assistive diagnosis,guidance for drug use,long-term follow-up and reduce of the incidence of coronary artery lesions.