Abstract 169: Impact of Resistance to Intravenous Immune Globulin on Changes of Left Ventricular Myocardial Deformation Over Time in Children with Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Soo Jung Kang ◽  
Dong Keon Yon
Keyword(s):  
Kawasaki Disease ◽  
Immune Globulin ◽  
Acute Phase ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Intravenous Immune Globulin ◽  
Myocardial Mechanics ◽  
Convalescent Phase ◽  
The Impact ◽  
Over Time

Introduction: This study aimed to assess the impact of resistance to intravenous immune globulin(IVIG) on left ventricular(LV) myocardial deformation in children with Kawasaki disease(KD) during the acute and convalescent phases of illness. Few studies have elucidated the impact of resistance to IVIG on the progressive changes of myocardial mechanics over time in patients with KD. Methods: We studied 26 patients with KD and 8 normal control subjects. Of the 26 patients, 16 were IVIG non-responders. Echocardiograms were obtained during the acute and convalescent phases of KD. Standard echocardiographic data and peak systolic global LV longitudinal strain[strain(ε)] were obtained using vector velocity imaging. Results: During the acute phase of KD, peak systolic global LV longitudinal ε decreased significantly in both IVIG non-responders(-21.18 % ± 3.97) and responders(-20.94 % ± 3.15) compared to controls(-24.99 % ± 2.23). Although in the acute phase, LV ejection fraction(EF) was significantly higher in the IVIG non-responders(55.38 % ± 5.14) compared to the responders(50.2 % ± 6.53), peak systolic global LV longitudinal ε was not significantly higher in the IVIG non-responders compared to the responders. During the convalescent phase, peak systolic global LV longitudinal ε tended to increase in non-responders(-21.62% ± 3.98) and responders(-21.83% ± 2.61) compared to the acute phase, but remained significantly decreased in both groups compared to controls. The increment of peak systolic global LV longitudinal ε from acute to convalescent phase tended to be smaller in the IVIG non-responders compared to the responders. The proportion of patients with coronary dilatations in both IVIG non-responders(4 of 16) and IVIG responders(2 of 10) did not differ significantly. Conclusions: The increment of peak systolic global LV longitudinal ε over time tended to be smaller in the IVIG non-responders compared to the IVIG responders. Resistance to IVIG may delay normalization of myocardial mechanics in IVIG non-responders. Further studies with larger number of patients, as well as long-term follow-up of myocardial deformation in KD are necessary.

Analyses of Left Ventricular Myocardial Deformation by Speckle-Tracking Imaging During the Acute Phase of Kawasaki Disease

2010 ◽  
Vol 31 (6) ◽  
pp. 807-812 ◽  
Author(s):  
Jeong Jin Yu ◽  
Hyung Soon Choi ◽  
Yong Beom Kim ◽  
Jae Sung Son ◽  
Young-Hwue Kim ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Acute Phase ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Speckle Tracking Imaging

scholarly journals Intimal thickening and disruption of the media occur in the arterial walls of coronary arteries not associated with coronary arterial aneurysms in patients with Kawasaki disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomoya Tsuchihashi ◽  
Nobuyuki Kakimoto ◽  
Takashi Takeuchi ◽  
Tomohiro Suenaga ◽  
Takayuki Suzuki ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Acute Phase ◽  
Coronary Arteries ◽  
Structural Changes ◽  
Artery Aneurysm ◽  
Intimal Thickening ◽  
Structure Damage ◽  
Convalescent Phase ◽  
Arterial Structure ◽  
The Media

Abstract Background Coronary artery aneurysm (CAA) is an important complication of Kawasaki disease (KD) that is associated with arterial structure damage. However, few studies have examined structural changes in coronary arteries that are not associated with CAA. Methods We examined coronary arteries in KD patients with CAAs who underwent follow-up coronary angiography (CAG) and optical coherence tomography (OCT). Coronary arterial branches with no abnormal findings during the most recent CAG were classified into two groups. Arteries with an acute-phase CAA that later regressed were classified as group R; arteries with no abnormal findings on either acute or convalescent phase CAG were classified as group N. Coronary arterial wall structural changes were compared between groups using OCT. Results Fifty-seven coronary arterial branches in 23 patients were evaluated by OCT. Thirty-six branches showed no abnormality during the most recent CAG. Both groups R and N comprised 18 branches. Maximum intimal thicknesses in groups R and N were 475 and 355 µm, respectively (p = 0.007). The incidences of media disruption were 100% and 67%, respectively (p = 0.02). Calcification, macrophage accumulation, and thrombus were not found in either group. Conclusions Intimal thickening and disruption of the media occur in coronary arteries with acute phase CAAs that later regress in the convalescent phase, as well as in arteries with normal CAG findings in the acute and convalescent phases.

Abstract 135: Effectiveness Of Live Vaccines Following Intravenous Immune Globulin Therapy During The Convalescent Phase Of Kawasaki Disease Using The Schedule Recommended In Japan

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Yoshihiko Morikawa ◽  
Masaru Miura ◽  
Hiroshi Sakakibara ◽  
Keyword(s):  
Kawasaki Disease ◽  
Immune Globulin ◽  
Past History ◽  
The United States ◽  
Vaccination Schedule ◽  
Vaccine Virus ◽  
Intravenous Immune Globulin ◽  
Serious Adverse Events ◽  
Live Virus ◽  
Varicella Zoster

Background: There are differences between Japan and the United States regarding recommended timing of live virus vaccinations after treatment of Kawasaki disease patients with intravenous immune globulin (IVIG): 6 months in Japan and 11 months in the U.S. The prevalence of antibodies to these vaccines using either vaccination schedule remains undetermined. Objective: The present study aimed to evaluate the effectiveness of the live virus vaccination schedule for Kawasaki disease recommended in Japan. Methods: This was a prospective observational study. Kawasaki disease patients aged 6 months and older without past history of or vaccination against measles, rubella, varicella-zoster (VZ), or mumps were enrolled. The children were vaccinated against measles, rubella, VZ, and mumps 6 months after IVIG. Serologic tests for IgG-class specific antibodies to each vaccine virus were performed prior to IVIG; 2 days, 3 months, and 6 months after IVIG, and 3 months after vaccination. The primary outcome was seroprevalence of positive antibodies, which was defined as serum concentration more than 4 IU/mL. Results: A total of 24 children (mean month age 16.8 ± 2.7 at vaccinations, 70.8% male) were enrolled. The rate of measles, rubella, VZ, and mumps seropositivity was 12.5% (3/24), 0% (0/24), 12.5% (3/24), and 0% (0/24), respectively, just before vaccination. The rate increased to 91.7% (22/24), 87.5% (21/24), 20.8% (5/24), and 8.3% (2/24), respectively, 3 months after vaccination. There were no serious adverse events. Conclusions: Use of the Japanese vaccination schedule led to extremely low seroprevalence of VZ and mumps antibodies but acceptable seroprevalence of measles and rubella antibodies. This study is ongoing and more cases (up to 30, the target sample size) are needed before the appropriateness of the timing of vaccination in Japan can be discussed.

scholarly journals Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age

2020 ◽  
Vol 30 (9) ◽  
pp. 1238-1246
Author(s):  
Gloria C. Lehmann ◽  
Philip T. Levy ◽  
Meghna D. Patel ◽  
Timothy Sekarski ◽  
HongJie Gu ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Neonatal Period ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Term Infants ◽  
Apical Rotation ◽  
Cardiopulmonary Complications ◽  
Rotational Mechanics ◽  
The Impact ◽  
Over Time

AbstractBackground:Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.Methods:Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.Results:Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).Conclusion:This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.

Brain natriuretic peptide can be a useful biochemical marker for myocarditis in patients with Kawasaki disease

2002 ◽  
Vol 12 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Takashi Kawamura ◽  
Masakuni Wago
Keyword(s):  
Kawasaki Disease ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Acute Phase ◽  
Biochemical Marker ◽  
Cross Sectional ◽  
T Wave ◽  
Convalescent Phase ◽  
The Mean ◽  
St Segments

So as to determine the value of brain natriuretic peptide in the plasma as a biochemical marker for myocarditis of Kawasaki disease, we studied 69 patients. The blood samples, electrocardiograms and cross-sectional echocardiograms were obtained before the commencement of treatment and in the convalescent phase. Results: The mean concentration of brain natriuretic peptide in the plasma was 73.2 ± 107.7 (mean ± SD) pg/ml in the acute phase, and 7.9 ± 7.5 pg/ml in the convalescent phase. We checked the electrocardiograms to find abnormal Q waves, elevation or depression of the ST segments, change in the pattern of the QRS complexes, and flattening or inversion of the T wave, all believed to be markers of myocarditis in Kawasaki disease. Those in whom the concentrations were greater than 50 pg/ml in the acute phase showed abnormal electrocardiograms more frequently than did those in whom the values were less than 50 pg/ml (21/29 vs 3/40, p < 0.0001 odds ratio 32.4). Amplitudes of the T wave in standard limb leads were measured both in the acute and convalescent phases, and the differences calculated. We regarded the sum total of these differences as representing “flattening T wave”, and we named this variable as the total suppressed T wave voltage. We examined the correlation between the variable and the levels of brain natriuretic peptide in the plasma during the acute phase, demonstrating a significant correlation (r = 0.500, p < 0.0001). We conclude, therefore, that the concentration of brain natriuretic peptide measured in the plasma can be a useful biochemical marker for the myocarditis of Kawasaki disease. When the titer is over 50 pg/ml, the patient probably has an abnormal electrocardiogram and is most likely to have myocarditis.

P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alfarih ◽  
C Leu ◽  
J Moon ◽  
A Hughes ◽  
P Nihoyannopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
P Value ◽  
Compensatory Mechanisms ◽  
Surgical Aortic Valve Replacement ◽  
The Impact

Abstract Introduction Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR. Aim To assess the impact of unloading LV after TAVI and SAVR on LV remodelling. Methods In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention. Results Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation. Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences. Conclusion Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.

Abstract 248: Prospective Study of Ventricular Function and Survival in Acute Phase of Chagas Disease: An Animal Experimental Model

2020 ◽  
Vol 127 (Suppl_1) ◽  
Author(s):  
Arthur L Vargas ◽  
Beatriz P Dias ◽  
Henrique T Moreira ◽  
Denise M Tanaka ◽  
Edgard C Oliveira Filho ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Experimental Model ◽  
Chagas Disease ◽  
Acute Phase ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Vector Transmission ◽  
Ventricular Ejection Fraction ◽  
Over Time ◽  
Animal Experimental Model

Background: Acute Cardiomyopathy secondary to Chagas disease is often subclinical when related to vector transmission. However, cases related to non-vector transmission as in patients submitted to cardiac transplant may have fatal outcomes. This study aimed to assess survival during the acute phase of Chagas disease and its relation to the ventricular function in an animal experimental model. Methods: Female Syrian hamsters (n=45) were separated in two groups: control group (CG):15 animals injected with saline solution; and infected group (IG): 30 animals inoculated with 3,5x10 4 trypomastigote forms of Trypanosoma cruzi,Y strain . Both groups were monitored daily and submitted to echocardiography with equipment dedicated to small animals (Vevo® 2100) in two different moments: baseline (before infection) and 15 days post infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of left ventricle were measured. The IG was divided into animals with and without clinical sign (CS+) of disease: weight or fur loss, mucous wounds and lethargy. ANOVA for mixed models was used to compare the ventricular function parameters among groups over time. Survival analysis was studied using Kaplan-Meier curves and logrank test. Results: Total time follow up was 60 days. LVEF in IG was significantly reduced through time (53.80 ± 4.95 to 43.55 ± 12.10%) compared to CG (57.86 ± 7.52 to 59.73 ± 5.87%) (p=0.002). There was also a significant reduction of GLS (-18.97 ± 3.94 to -12.44 ± 4.79%) in the IG compared to CG (-19.58 ± 4.03 to -19.67 ± 4.04%) (p=0.012). Twelve animals from IG died (40.00%,12 out of 30) compared to one from CG (6.66%, 1 out of 15). Eleven out of the 12 dead animals from IG, presented, before, clinical signs (CS+). Survival was significant reduced in the IG compared to CG over time (p=0.02) (Figure 1). Conclusion: Reduced survival during the acute phase of experimental model of Chagas disease is related to the significant reduction of left ventricular function. The mortality rate in the IG is higher in the group which presents CS+.

Noncoronary Inflammation in Kawasaki Disease is Associated with Abnormal Myocardial Deformation in the Acute Phase

2014 ◽  
Vol 27 (12) ◽  
pp. 1329-1335 ◽  
Author(s):  
Lasya Gaur ◽  
Kevin Waloff ◽  
Ofer Schiller ◽  
Craig A. Sable ◽  
Lowell H. Frank
Keyword(s):  
Kawasaki Disease ◽  
Acute Phase ◽  
Myocardial Deformation
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