Abstract 172: Tissue Doppler Imaging as a Predictor of Immunoglobulin Resistance in Kawasaki Disease
Background: Kawasaki disease (KD) causes myocarditis and left ventricular dysfunction during the acute phase of the illness. Despite treatment with intravenous immunoglobulin (IVIG), a significant number of patients are IVIG resistant (fail to defervesce or experience recrudescent fever). We evaluated KD patients in the acute phase using Tissue Doppler Imaging (TDI) to assess if myocardial dysfunction may predict IVIG resistance.
Methods: All patients with acute KD presenting to Children’s Hospital Colorado from February, 2007 to March, 2014 were included in this study. All patients underwent echocardiograms with TDI (pulsed wave sample Doppler were placed at the tricuspid, septal, and mitral annuli) upon diagnosis with KD. Patients were divided into two groups: IVIG Responder group and IVIG Resistant group. Group differences were assessed using Wilcoxon-Mann-Whitney and Chi-square testing. Receiver Operating Characteristic (ROC) Curve analysis was utilized to determine threshold values of TDI measurements associated with IVIG resistance.
Results: Fifty-one age matched (+/- 6 months) IVIG Responder patients were compared to 51 IVIG Resistant group [33.49 (17.30 - 62.89) months vs 44.57 (20.13 - 77.07) months, p <0.44]. There were 34 males in Responder group versus 33 males in Resistant group (p< 0.83). There were significant differences in the tricuspid, septal, and mitral early diastolic velocities (E’) (p< 0.05, p< 0.001 and p<0.01) respectively. ROC analysis demonstrated that tricuspid E’ < 0.15 cm/s, septal E’ < 0.12 cm/s, and mitral E’ < 0.16 cm/s were good predictors of IVIG unresponsiveness (AUC = 0.66, 0.66, and 0.70 respectively). There were no differences between the systolic velocities (S’) or late diastolic velocities (A’).
Conclusions: IVIG resistant KD patients present with significantly greater diastolic dysfunction compared to responders in patients with KD. TDI may be a useful tool to differentiate KD patients who may be IVIG resistant.
Author Disclosures: D.R. Phadke: None. S.S. Patel: None. S.R. Dominguez: None. H.R. Heizer: None. M. Anderson: None. M.P. Glode: None. P. Jone: None.
- © 2015 by American Heart Association, Inc.