Left ventricular systolic dyssynchrony in patients with Kawasaki disease: a real-time three-dimensional echocardiography
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ORIGINAL PAPER
Left ventricular systolic dyssynchrony in patients with Kawasaki disease: a real-time three-dimensional echocardiography study Haiyong Wang1 · Yan Song1 · Jingjing Mu1 · Jing Shang1 · Jiabing Wang2 · Litao Ruan1 Received: 9 February 2020 / Accepted: 1 June 2020 © Springer Nature B.V. 2020
Abstract The left ventricular (LV) systolic dyssynchrony index (SDI) is an important prognostic indicator for many cardiovascular diseases; however, the characteristics of the SDI in patients with Kawasaki disease (KD) are unknown. In this study, we aimed to identify and quantify the SDI using real-time three-dimensional echocardiography (RT3DE) in KD patients during different phases. In addition, we intended to explore whether the SDI is associated with systolic dysfunction. Seventy consecutive KD patients and seventy age- and sex-matched controls were enrolled. The SDIs (percent of cardiac cycle) of 16 segments (16-SDI%) and 12 segments (12-SDI%) were calculated based on the defined standard deviation of each segment time from end diastole to the minimal systolic volume according to the 17-segment model (apex excluded). In the acute phase, the 16-SDI% and 12-SDI% were significantly higher in KD patients than in controls (4.40 ± 0.14 vs. 1.98 ± 0.12, P = 0.000; 3.55 ± 1.21 vs. 1.67 ± 0.93, P = 0.009, respectively), and patients with coronary artery aneurysm (CAA) exhibited higher 16-SDI% (P = 0.021) and 12-SDI% (P = 0.034) than patients without CAA. In the convalescent phase, patients with CAA still had higher 16-SDI% (P = 0.002) and 12-SDI% (P = 0.031) than controls, while the SDI in patients without CAA recovered to normal. The 16-SDI% was negatively correlated with the LV ejection fraction obtained from RT3DE (r = − 0.845, P = 0.000). Mechanical dyssynchrony is prevalent in KD patients during the acute phase and transient in patients without CAA, while patients with CAA still have impaired synchrony even in the convalescent phase. LV systolic dysfunction is associated with increased dyssynchrony. RT3DE is a valuable modality for identifying and quantifying dyssynchrony in KD patients. Keywords Kawasaki disease · Dyssynchrony · Left ventricle · Real-time three-dimensional echocardiography Abbreviations SDI Systolic dyssynchrony GLS Global longitudinal strain 2DSTE Two dimensional speckle tracking echocardiography RT3DE Real-time three-dimensional echocardiography LVEDV Left ventricular end diastolic volume LVESV left ventricular end systolic volume LVEF Left ventricular ejection fraction LV Left ventricular/left ventricle
KD Kawasaki disease RT3DE Real-time three-dimensional echocardiography CAA Coronary artery aneurysm 16-SDI% 16-segment systolic dyssynchrony index 12-SDI% 12-segment systolic dyssynchrony index IVIG Intravenous immunoglobulin Ts-SD-12 Standard deviation of time to peak systolic velocity of 12 segments
* Litao Ruan [email protected]
Kawasaki disease (KD) is an acute systemic vasculitis with an unknown cause that mainly affects children
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