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Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease

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Abstract

Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e′), and lower median TV e′ velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e′ in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population.

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References

  1. Ajami G, Borzouee M, Amoozgar H, Ashnaee F, Kashef S, Nesar MS, Nesar MS (2010) Evaluation of myocardial function using the Tei index in patients with Kawasaki disease. Cardiol Young 20:44–48

    Article  PubMed  Google Scholar 

  2. Akagi T, Kato H, Inoue O, Sato N, Imamura K (1990) Valvular heart disease in Kawasaki syndrome: incidence and natural history. Am Heart J 120:366–372

    Article  CAS  PubMed  Google Scholar 

  3. Bartter T, Irwin RS, Nash G (1988) Aneurysms of the pulmonary arteries. Chest 94:1065–1075

    Article  CAS  PubMed  Google Scholar 

  4. Baughman KL (2006) Diagnosis of myocarditis: death of Dallas criteria. Circulation 113:593–595

    Article  PubMed  Google Scholar 

  5. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  PubMed  Google Scholar 

  6. Burns JC, Glode MP (2004) Kawasaki syndrome. Lancet 364:533–544

    Article  PubMed  Google Scholar 

  7. Dallaire F, Dahdah N (2011) New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 24:60–74

    Article  PubMed  Google Scholar 

  8. Dominguez SR, Friedman K, Seewald R, Anderson MS, Willis L, Glode MP (2008) Kawasaki disease in a pediatric intensive care unit: a case-control study. Pediatrics 122:e786–e790

    Article  PubMed  Google Scholar 

  9. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, White JA, Abdel-Aty H, Gutberlet M, Prasad S, Aletras A, Laissy JP, Paterson I, Filipchuk NG, Kumar A, Pauschinger M, Liu P (2009) Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol 53:1475–1487

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hama Y, Funabashi N, Ueda M, Kanaeda T, Uehara M, Nakamura K, Murayama T, Mikami Y, Takaoka H, Kawakubo M, Lee K, Takano H, Komuro I (2009) Images in cardiovascular medicine. Right-sided heart wall thickening and delayed enhancement caused by chronic active myocarditis complicated by sustained monomorphic ventricular tachycardia. Circulation 119:e200–e203

    Article  PubMed  Google Scholar 

  11. Harada K, Tamura M, Toyono M, Yasuoka K (2002) Comparison of the right ventricular Tei index by tissue Doppler imaging to that obtained by pulsed Doppler in children without heart disease. Am J Cardiol 90:566–569

    Article  PubMed  Google Scholar 

  12. Harada M, Yokouchi Y, Oharaseki T, Matsui K, Tobayama H, Tanaka N, Akimoto K, Takahashi K, Kishiro M, Shimizu T, Takahashi K (2012) Histopathological characteristics of myocarditis in acute-phase Kawasaki disease. Histopathology 61:1156–1167

    Article  PubMed  Google Scholar 

  13. Hashimoto I, Watanabe K, Okabe M, Kaneda H (2015) Impairment of left ventricular longitudinal contraction is associated with serum brain natriuretic peptide concentration in patients with acute-phase Kawasaki disease. Pediatr Cardiol 36:979–986

    Article  PubMed  Google Scholar 

  14. Ho CH, Wu YC, Lin YY, Hsu CW, Tsai SH (2010) Postural hypotension as the initial presentation of fulminant right ventricular myocarditis. Am J Emerg Med 28:708–710

    Article  PubMed  Google Scholar 

  15. Kanegaye JT, Wilder MS, Molkara D, Frazer JR, Pancheri J, Tremoulet AH, Watson VE, Best BM, Burns JC (2009) Recognition of a Kawasaki disease shock syndrome. Pediatrics 123:e783–e789

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94:1379–1385

    Article  CAS  PubMed  Google Scholar 

  17. Lin YJ, Lin IC, Yu HR, Kuo HC, Yang KD, Chang WC, Liang CD, Liu SF, Kuo HC (2013) Tricuspid regurgitation in acute phase of Kawasaki disease associated with intensive care unit admission. Pediatr Cardiol 34:250–255

    Article  PubMed  Google Scholar 

  18. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23:465–495 (Quiz 576-467)

    Article  PubMed  Google Scholar 

  19. Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, Vogelsberg H, Fritz P, Dippon J, Bock CT, Klingel K, Kandolf R, Sechtem U (2006) Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 114:1581–1590

    Article  PubMed  Google Scholar 

  20. Mancio J, Bettencourt N, Oliveira M, Pires-Morais G, Ribeiro VG (2013) Acute right ventricular myocarditis presenting with chest pain and syncope. BMJ Case Rep 2013

  21. Matsuoka Y, Sennari E, Hayakawa K (1987) Idiopathic myocarditis characterized by marked right ventricular dilatation. Report of two autopsy cases. Jpn Circ J 51:51–58

    Article  CAS  PubMed  Google Scholar 

  22. Mavrogeni S, Papadopoulos G, Karanasios E, Georgakopoulos D, Manoussakis MN (2010) Microscopic polyangiitis and Kawasaki disease without overt clinical cardiovascular manifestations and with abnormal cardiovascular magnetic resonance findings. Int J Cardiol 141:e17–e19

    Article  CAS  PubMed  Google Scholar 

  23. McFalls EO, van Suylen RJ (1993) Myocarditis as a cause of primary right ventricular failure. Chest 103:1607–1608

    Article  CAS  PubMed  Google Scholar 

  24. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA, Committee on Rheumatic Fever E, Council on Cardiovascular Disease in the Y, American Heart A, American Academy of P, Kawasaki D (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110:2747–2771

    Article  PubMed  Google Scholar 

  25. Nicholson GT, Samai C, Kanaan U (2013) Pulmonary hypertension in Kawasaki disease. Pediatr Cardiol 34:1966–1968

    Article  PubMed  Google Scholar 

  26. Oh JK, Seward JB, Tajik AJ (2006) The echo manual. Stroke volume and cardiac output, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 69–70

    Google Scholar 

  27. Printz BF, Sleeper LA, Newburger JW, Minich LL, Bradley T, Cohen MS, Frank D, Li JS, Margossian R, Shirali G, Takahashi M, Colan SD (2011) Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease. J Am Coll Cardiol 57:86–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ravekes WJ, Colan SD, Gauvreau K, Baker AL, Sundel RP, van der Velde ME, Fulton DR, Newburger JW (2001) Aortic root dilation in Kawasaki disease. Am J Cardiol 87:919–922

    Article  CAS  PubMed  Google Scholar 

  29. Roberson DA, Cui W (2007) Right ventricular Tei index in children: effect of method, age, body surface area, and heart rate. J Am Soc Echocardiogr 20:764–770

    Article  PubMed  Google Scholar 

  30. Sugimoto M, Ishido H, Seki M, Masutani S, Tamai A, Senzaki H (2012) Findings in the pulmonary vascular bed in the remote phase after Kawasaki disease. Am J Cardiol 109:1219–1222

    Article  PubMed  Google Scholar 

  31. Yonesaka S, Takahashi T, Matubara T, Nakada T, Furukawa H, Tomimoto K, Oura H (1992) Histopathological study on Kawasaki disease with special reference to the relation between the myocardial sequelae and regional wall motion abnormalities of the left ventricle. Jpn Circ J 56:352–358

    Article  CAS  PubMed  Google Scholar 

  32. Yu JJ, Choi HS, Kim YB, Son JS, Kim YH, Ko JK, Park IS (2010) Analyses of left ventricular myocardial deformation by speckle-tracking imaging during the acute phase of Kawasaki disease. Pediatr Cardiol 31:807–812

    Article  PubMed  Google Scholar 

  33. Yutani C, Go S, Kamiya T, Hirose O, Misawa H, Maeda H, Kozuka T, Onishi S (1981) Cardiac biopsy of Kawasaki disease. Arch Pathol Lab Med 105:470–473

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Pei-Ni Jone, Division of Cardiology, Dept. of Pediatrics, University of Colorado School of Medicine, Denver, CO, and Dr. Nagib Dahdah, Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, CA, for their expert guidance and helpful discussion.

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Authors and Affiliations

  1. Departments of Pediatrics, San Diego School of Medicine, University of California, San Diego, USA

    Fujito Numano, Chisato Shimizu, Adriana H. Tremoulet & Jane C. Burns

  2. Rady Children’s Hospital San Diego, San Diego, USA

    Adriana H. Tremoulet, Dan Dyar, Jane C. Burns & Beth F. Printz

  3. Department of Pediatrics, UCSD School of Medicine, Kawasaki Disease Research Center, 9500 Gilman Dr., La Jolla, CA, 92093-0641, USA

    Fujito Numano

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  1. Fujito Numano
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Correspondence to Fujito Numano.

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Numano, F., Shimizu, C., Tremoulet, A.H. et al. Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease. Pediatr Cardiol 37, 482–490 (2016). https://doi.org/10.1007/s00246-015-1303-5

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  • DOI: https://doi.org/10.1007/s00246-015-1303-5

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