Abstract 16918: Myocardial Mechanics in Kawasaki Disease: Relationship to Degree of Systemic Inflammation and Coronary Artery Dilation
Background: Myocardial function may be decreased in patients with acute Kawasaki Disease. It is unclear if depressed function is related to inflammation, coronary artery changes, or both. We hypothesized that patients with depressed function, as assessed by myocardial strain and strain rate, would demonstrate higher inflammatory markers but no difference in early proximal coronary artery dilatation.
Methods: We retrospectively reviewed Kawasaki Disease patients seen at our institution between 2009 and 2013 who had a pre-treatment C-reactive protein and echocardiogram, as well as stored pre-treatment blood for procalcitonin analysis. Myocardial strain and strain rate were measured by velocity vector imaging from pre-treatment echo images. Two-sample t-tests were employed to analyze the median procalcitonin, C-reactive protein, and coronary artery z-scores in patients with normal versus depressed longitudinal and circumferential strain/strain rate.
Results: A total of 41 Kawasaki Disease patients met study criteria. Median procalcitonin levels were significantly higher in patients with depressed longitudinal strain compared to patients with preserved strain (1.2 vs 0.3ng/ml; p<0.05). Similar differences in median procalcitonin levels were seen in patients with depressed versus preserved circumferential strain (1.8 vs 0.4ng/ml; p<0.05). Median CRP levels trended higher in patients with depressed longitudinal strain (10.9 vs 4.9mg/dl; p=0.11) and circumferential strain (10.0 vs 5.2mg/dl; p=0.5), but these differences were not statistically significant. Patients with depressed strain showed no difference in coronary artery z-scores compared to patients with preserved strain. Depressed strain rate was not associated with differences in inflammatory markers or coronary artery z-scores.
Conclusion: Depressed myocardial strain during acute Kawasaki Disease appears to be more closely tied to inflammatory state than to the presence of early proximal coronary artery dilation. Procalcitonin is more markedly altered than CRP in patients with depressed myocardial strain and shows promise as a marker of myocardial inflammation in this population.
- © 2013 by American Heart Association, Inc.