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An exercise tissue Doppler and strain rate imaging study of diastolic myocardial dysfunction after Kawasaki syndrome in childhood

Published online by Cambridge University Press:  01 October 2007

Raoul Arnold ,
Björn Goebel ,
Herbert E. Ulmer ,
Matthias Gorenflo  and
Tudor C. Poerner
Raoul Arnold*
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany Department of Paediatric Cardiology, University Hospital Freiburg, Germany
Björn Goebel
Affiliation:
1st Department of Medicine, University Hospital Jena, Germany
Herbert E. Ulmer
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
Matthias Gorenflo
Affiliation:
Department of Paediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
Tudor C. Poerner
Affiliation:
1st Department of Medicine, University Hospital Jena, Germany
*
Correspondence to: Raoul Arnold, MD, University Hospital Freiburg, Department of Paediatric Cardiology, Mathildenstraße 1, D-79106 Freiburg, Germany. Tel: +49 761 270 4318; Fax: +49 761 270 4468; E-mail: [email protected]
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Abstract

Objective

Myocardial dysfunction due to coronary arterial lesions is an important complication after Kawasaki syndrome in childhood. Tissue Doppler echocardiography, and strain rate imaging, have shown their value in detecting regional myocardial dysfunction in coronary arterial disease. We aimed to examine the diagnostic value of these methods in patients with coronary arterial lesions after Kawasaki syndrome.

Methods

We assessed regional myocardial function in 17 asymptomatic patients with coronary arterial lesions. Follow-up coronary angiographies were available in all cases. Tissue Doppler echocardiography, and strain rate imaging, were performed at rest and during bicycle exercise. Examination included peak systolic and diastolic velocities, peak systolic strain and strain rate. We enrolled 17 age- and gender-matched persons to serve as a control group.

Results

Segmental left ventricular longitudinal function did not significantly differ between the groups with respect to peak systolic velocity, strain, and strain rate. Diastolic abnormalities were identified in segments supplied by coronary arteries with stenotic lesions. Peak diastolic velocity decreased significantly during exercise in those areas, from 77 plus or minus 34 to 59 plus or minus 56 millimetres per second, p smaller than 0.05. Under exercise, a peak diastolic velocity value under 90 millimetres per second enabled us to identify coronary arterial stenosis with a sensitivity of 75 percent and specificity of 64 percent.

Conclusions

After Kawasaki syndrome, diastolic impairment develops in segments supplied by stenotic coronary arteries before systolic dysfunction is detectable. Exercise tissue Doppler echocardiography has the potential to detect these subtle abnormalities, and help monitor progression of the disease.

Keywords

Mucocutaneous lymph node syndromeregional heart functionechocardiographyexercise testing
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007 , pp. 478 - 486
Copyright
Copyright © Cambridge University Press 2007

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