Correlation Analysis of Anti-Cardiolipin Antibody/D Dimer/C-Reactive Protein and Coronary Artery Lesions/Multiple-Organ Damage in Children With Kawasaki Disease

Aim: Kawasaki disease (KD) is a systemic vasculitis with unknown etiology. In addition to cardiovascular system involvement, it can also have other multiple organs involved. This study is aimed at investigating the correlation between anti-cardiolipin antibody (ACA)/D dimer/C reactive protein (CRP) and coronary artery lesions (CAL)/multiple-organ lesions in children with KD.Methods: Retrospective analysis was performed in 284 KD/IKD patients from May 2015 to April 2016. Among them, 175 were males (61.6%), with average age of 2 years and 5 months old. Patients were divided into ACA+ group and ACA- group, elevated D dimer group (DDE) and normal D dimer group (DDN), and coronary artery injury (CAL) group and non-coronary artery injury (NCAL) group.Results: ACA was most likely tested positive in younger KD children (p < 0.05). ACA+ and hypoproteinemia were correlated with CAL, thrombocytosis, and granulocytopenia (p < 0.05–0.01). Levels of cTnI and CK in the CAL group were significantly higher than those in the NCAL group (p < 0.05). CAL was more frequently detected in younger patients and patients with prolonged fever, later IVIG treatment, and elevated CRP over 100 mg/l, but there was no statistically significant difference (all p > 0.05). In the KD with DDE group, the incidence of granulopenia, thrombocytosis, myocardial damage, cholestasis, hypoproteinemia, and aseptic urethritis was significantly higher than that in the KD with DDN group (p < 0.05–0.01). However, elevated D dimer was not associated with CAL. CRP elevation was highly correlated with D dimer, but not with CAL.Conclusion: Higher incidence of CAL and myocardial damage occurred in KD patients with positive ACA and hypoproteinemia. In the current study, ACA was only tested for positive and negative, which is a limitation to this study. To further elucidate the association, ACA titers would establish its significance in drawing a conclusion for the significance of ACA in CAL and myocardial damages. In addition, higher incidence of CAL occurred in younger patients. The higher D dimer was associated with increased multiple-organ damage (MOD). CRP was closely correlated with D dimer, but not correlated with ACA and CAL.

Protective Effect of TNFRSF11A rs7239667 G > C Gene Polymorphism on Coronary Outcome of Kawasaki Disease in Southern Chinese Population

BackgroundThe main symptoms of Kawasaki disease (KD) are inflammatory vasculitis characterized by fever lasting 1–2 weeks, failure to respond to antibiotic treatment, conjunctivitis, redness of the lips and mouth, strawberry tongue, and painless enlargement of the neck lymph nodes. Studies have been shown that tumor necrosis factor (TNF) and TNF receptor family members are abnormally expressed in the acute phase of Kawasaki disease, also revealing that these two play a significant role in the pathogenesis of KD. The purpose of our study is to determine the relationship between TNFRSF11A rs7239667 and the pathogenesis of KD and Coronary artery lesions in KD.Methods and ResultsIn this study, TNFRSF11A (rs7239667) genotyping was performed in 1396 patients with KD and 1673 healthy controls. Our results showed that G > C polymorphism of TNFRSF11A (rs7239667) was not associated with KD susceptibility. In addition, the patients with KD were divided into CAA and NCAA groups according to whether they had coronary artery aneurysm (CAA) or not, and the TNFRSF11A rs7239667 genotyping was performed in the two groups. After gender and age calibration, We found that genotype CC of TNFRSF11A may be a protective factor in KD coronary artery damage (adjusted OR = 0.69 95% CI = 0.49–0.99 P = 0.0429) and is more significant in children with KD ≤ 60 months (adjusted OR = 0.49 95% CI = 0.49–0.93 P = 0.0173).ConclusionOur study suggests that TNFRSF11A rs7239667 G > C polymorphism maybe play a protective gene role for the severity of KD coronary artery injury and is related to age, which has not been previously revealed.

Significance of Plasma Circulating Endothelial Microparticles Combined with Von Willebrand Factor in Coronary Injury of Kawasaki Disease

Background:The greatest complication of Kawasaki disease (KD) is coronary artery injury, and the requirement for early diagnosis and treatment is paramount. Thus, markers of vascular endothelial injury are of important clinical significance. Methods:According to our diagnostic criteria, blood samples were collected from 43 patients with KD, who were then divided into coronary artery lesions (CALs) and non-CALs (NCALs) groups according to their Z-score. As the control group, an additional 26 blood samples were collected from healthy children. Flow cytometry (FCM) and enzyme-linked immunosorbent assays (ELISA) were used to detect the expression levels of plasma endothelial microparticles (EMPs) and von Willebrand factor (vWF). Results:The expression levels of plasma CD31+/CD42b-EMPs, CD105+/CD54+EMPs, and vWF were higher in children with KD than those in the control group, and the differences were statistically significant (P<0.05).Also, the expression levels of CD31+/CD42b-EMPs, CD105+/CD54+EMPs and vWF in those in the CALs group at the acute and subacute stages were significantly higher than those in the NCALs group (P<0.05). Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of CD31+/CD42b-EMPs combined with vWF was 0.896, which indicates a higher diagnostic value in predicting CALs in children with KD. Conclusions:In our study, expression levels of EMPs and vWFare expected to used for early diagnosis, and which are associated with coronary artery injury in KD.

Redo mitral valve replacement using valve-on-valve technique in a patient with severe posterior mitral annular calcification

Redo mitral valve replacement surgery due to bioprosthetic valve failure can carry serious surgical challenges. In addition to the usual redo sternotomy risk, there is risk of circumflex coronary artery injury or atrioventricular disruption from explanting the prosthesis. Alternatives to prosthesis explantation may be needed in some cases.We report a case of mitral bioprosthetic valve failure in a young patient who had a history of atrioventricular disruption during the first surgery and had pericardial patch repair of the defect. The risk of explanting the bioprosthesis during redo surgery was very high. Therefore, we performed valve replacement using valve-on-valve technique in which the new valve is implanted within the sewing ring of the previous bioprosthesis without explanting the valve. This technique converted a very highly futile surgery to a conventional redo surgery risk. The patient had a successful surgery with no intraoperative or postoperative complications.

Vitamin D as a Substitute of Catheter Ablation in a Paediatric Patient with High Burden Premature Ventricular Contractions: A Case Report

Catheter ablation is established as a treatment option for patients with high number Premature Ventricular Contractions (PVCs). However, complications can occur: cardiac tamponade, coronary artery injury or infectious endocarditis. Reversible causes such as hypocalcaemia, hypomagnesaemia and hypokalemia can be responsible for PVCs. Here, a case of nine years old boy, with vitamin D deficiency that presented high number PVCs which corrected using vitamin D dietary supplementation was described. A nine-year-old boy was hospitalised in the Cardiology Department for catheter ablation of PVCs. He presented short of breath during football matches and asthenia. Electrocardiography(ECG) and Holter ECG demonstrated high number PVCs with a morphology consistent of Right Ventricular Outflow Tract (RVOT) origin. Catheter ablation was postponed until Vitamin D came to normal values. Dietary supplementation was performed, together with Holter ECG monitoring. After vitamin D normalisation, PVC burden reduced significantly without the need of catheter ablation or anti-arrhythmic drugs. Catheter ablation and anti-arrhythmic drugs can be avoided in patients with frequent PVCs and vitamin D deficiency.

Proteomics Analysis of the Protective Effects of Hesperetin on Coronary Artery injury in Streptozotocin-Induced Type 1 Diabetic Rats

Background: Type 1 and type 2 diabetes both cause damage to the cardiovascular system. Hesperetin, a medicinal product found in foods, has been shown to have various cardioprotective effects. However, the effects of this compound on diabetes-related cardiovascular damage have not been evaluated.Methods: In this study, we aimed to investigate the protective effects of hesperetin on the coronary artery in diabetic rats and to explore its effects on the changes in critical proteins in the coronary artery using proteomics analysis. Results: Hesperetin alleviated coronary artery injury and modulated the expression of various proteins, including S100A8 and S100A9, which functioned in Toll-like receptor 4 binding, Toll-like receptor binding, and RAGE receptor binding. Pathways altered by hesperetin included type I diabetes mellitus, cell adhesion molecules, antigen processing and presentation, and interleukin-17 signaling pathway. Conclusions: In this study, we constructed a protein map of SD rats with type 1 diabetes treated with hesperetin, and found significant changes in three important proteins, S100A8, S100A9 and KNG1.Our findings provided important insights into further studies of the cardiovascular protective effects of hesperetin.