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CMR feature tracking in Kawasaki Disease convalescence

  • Konstantinos Bratis
  • Pauline Hackmann
  • Nicholas Child
  • Sophie Mavrogeni
  • Thomas Krasemann
  • Tarique Hussain
  • Rene Botnar
  • Reza Razavi
  • Gerald F Greil
Open Access
Poster presentation

Keywords

Kawasaki Disease Left Ventricular Systolic Function Kawasaki Disease Patient Normal Left Ventricular Systolic Function Coronary Artery Involvement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki Disease. Despite normal LV systolic function by routine functional measurements, reduced longitudinal strain (S) and strain rate (SR) have been detected by echocardiography in the acute phase, which may potentially predict late onset heart failure.

We aimed to determine whether left ventricular (LV) myocardial deformation indices can detect subclinical myocardial abnormalities in Kawasaki Disease (KD) convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persist in convalescence.

Methods

Peak systolic LV myocardial longitudinal, radial and circumferential S and SR (Figure 1) were examined in 29 KD convalescent patients (15 males; mean (SD) age 11 (6.6) years, range 3- 27 years; median interval from KD onset 5.8 (5.4) years) and 10 healthy volunteers (5 males; mean age 14 (3.8) years, range 6- 19 years) with the use of cardiac magnetic resonance feature tracking (CMR-FT). Routine indices of LV systolic function were normal in both groups.
Figure 1

CMR-FT post-processing. Short-axis apical (1), mid ventricular (2), basal (3) and 4-chamber long-axis (4) views with relevant endocardial contour drawn in a KD patient. Radial strain (A) and strain rate (B), circumferential strain (C) and strain rate (D) and longitudinal strain and strain rate (4, mid and lower row, respectively) results are provided below each slice. CMR-FT: Cardiac Magnetic Resonance Feature Tracking, KD: Kawasaki Disease

Results

Comparisons were made between normal controls and (i) the entire KD group, (ii) KD group subdivided by coronary artery involvement. (Table 1) Compared to controls, KD patients had lower longitudinal S. Average longitudinal and circumferential S at all levels was lower in KD patients compared normal controls. In subgroup analysis, both KD patients with and without any history of CAD had similar longitudinal and circumferential S at all levels and lower when compared against controls. There was a non-significant trend for lower circumferential and longitudinal values in KD patients with persisting CAD when compared against those with regressed CAD.
Table 1

Longitudinal, radial and circumferential global LV deformation analysis of KD patients and KD subgroups compared with controls.

 

Controls (n=10)

All KD (n=27)

 

KD with CAL

 

KD without CAL (n=5)

   

All (n=22)

Persistent CAL (n=13)

Regressed CAL (n=9)

 

Basal radial

 

Strain

28.2 (13.9)

31.2 (8.3)

31.8 (8.6)

30.3 (8.0)

34.1 (9.0)

26 (3.2)

Strain rate

1.4 (0.4)

1.6 (0.7)

1.7 (0.8)

1.6 (0.9)

1.7 (0.6)

1.3 (0.2)

Basal circumferential

 

Strain

28.2 (13.9)

23.7 (5.5)

23.1 (4.9)

22.0 (4.7)

24.9 (5.7)

23.1 (4.7)

Strain rate

1.4 (0.4)

1.5 (0.4)

1.5 (0.4)

1.5 (0.5)

1.5 (0.4)

1.3 (0.3)

Mid radial

 

Strain

29.0 (7.3)

30.5 (8.1)

30.1 (5.3)

31.1 (5.2)

31.9 (11.4)

28.2 (7.7)

Strain rate

1.6 (0.2)

1.7 (0.8)

1.7 (0.8)

1.7 (1.0)

1.7 (0.5)

1.3 (0.3)

Mid circumferential

 

Strain

23.8 (2.8)

21.1 (5.5)

21.0 (5.4)

20.9 (4.1)

22.2 (7.0)

21.9 (6.9)

Strain rate

1.7 (0.3)

1.4 (0.5)

1.4 (0.5)

1.4 (0.4)

1.5 (0.6)

1.3 (0.5)

Apical radial

 

Strain

11.7 (2.8)

14.9 (7.4)

16.3 (6.0)

15.6 (6.3)

17.3 (5.7)

17.0 (8.6)

Strain rate

1.8 (0.7)

1.4 (0.7)

1.4 (0.6)

1.5 (0.8)

1.4 (0.3)

1.3 (0.8)

Apical circumferential

 

Strain

24.9 (6.2)

21.7 (7.0)

22.0 (7.4)

21.0 (7.6)

24.5 (8.5)

17.4 (4.0)

Strain rate

1.9 (0.6)

1.6 (0.6)

1.6 (0.6)

1.6 (0.6)

1.8 (0.7)

1.4 (0.1)

Longitudinal

 

Strain

18.9 (7.8)

16.4 (5.4)

17.2 (4.9)

16.2 (4.5)

18.8 (5.4)

12.8 (6.8)

KD: Kawasaki Disease, CAL: Coronary Artery Lesion, *: p < 0.05

Conclusions

In this CMR-FT study in KD convalescent patients with preserved conventional functional indices, we observed a trend for lower circumferential and longitudinal strain in KD patients compared to normal controls, irrespective of their coronary artery status.

Funding

The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. The Division of Imaging Sciences receives also support as the Centre of Excellence in Medical Engineering (funded by the Welcome Trust and EPSRC; grant number WT 088641/Z/09/Z) as well as the BHF Centre of Excellence (British Heart Foundation award RE/08/03).

Copyright information

© Bratis et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Konstantinos Bratis
    • 1
  • Pauline Hackmann
    • 1
  • Nicholas Child
    • 1
  • Sophie Mavrogeni
    • 2
  • Thomas Krasemann
    • 3
  • Tarique Hussain
    • 1
  • Rene Botnar
    • 1
  • Reza Razavi
    • 1
  • Gerald F Greil
    • 1
  1. 1.King's College LondonLondonUK
  2. 2.Onassis Cardiac Surgery CentreAthensGreece
  3. 3.Evelina ChildreN HospitalLondonUK

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