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Barrios-Tascón A, Miura M, Domínguez-Rodríguez S, Fernández-Cooke E, Sarquella-Brugada G, Tagarro A. Ventricular Repolarization Parameters and Coronary Involvement in Kawasaki Disease. J Pediatr 2021; 236:108-112.e5. [PMID: 34004190 DOI: 10.1016/j.jpeds.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate electrocardiogram markers to predict coronary involvement in patients with Kawasaki disease by assessing measures of ventricular repolarization parameters on the 12-lead electrocardiogram. STUDY DESIGN This cross-sectional study included 180 Spanish and Japanese patients ≤14 years of age with Kawasaki disease, with or without coronary involvement, from 2011 to 2016. We manually measured the Tp-Te/QT ratio and QTc interval (with Bazett's formula) in 12-lead electrocardiogram in the acute and recovery period and explored their potential association with coronary involvement. RESULTS No association was found between Tp-Te/QT ratio obtained manually in V5 and V6 leads and coronary involvement in the acute (V5:0.25 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .80; V6:0.24 [IQR, 0.21-0.27] vs 0.25 [IQR, 0.20-0.27], P = .86) or the recovery (V5: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.19-0.25], P = .68; V6: 0.23 [IQR, 0.20-0.25] vs 0.23 [IQR, 0.17-0.25], P = .50) period. By contrast, QTc in V5 and V6 was significantly lower in patients with Kawasaki disease and coronary involvement in the acute period (V5: 378 ms [IQR, 364-395 ms] vs 390 ms [IQR, 371-411 ms], P = .04; V6: 377 ms [IQR, 364-392 ms] vs 390 ms [IQR, 371-410 ms], P = .01). A QTc interval of <385 ms in lead V6 was associated with a 2.5-fold increased risk of coronary involvement (OR, 2.5; 95% CI, 1.2-5.3; P = .02). CONCLUSIONS Manually measured QTc interval may be a marker of coronary disease in the acute period of Kawasaki disease.
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Affiliation(s)
- Ana Barrios-Tascón
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
| | - Masaru Miura
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Elisa Fernández-Cooke
- Traslational Research Network in Pediatric Infectious Diseases, Pediatrics Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alfredo Tagarro
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain; Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
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Mizutani Y, Kojima A, Takeuchi Y, Kusuki H, Sugimoto K, Osakabe K, Ichino N, Fujino M, Saito K, Miyata M, Sadanaga T, Hata T. Evaluation of perinatal autonomic development in infants using the QT/RR variability ratio. FUJITA MEDICAL JOURNAL 2020; 6:17-20. [PMID: 35111516 PMCID: PMC8766653 DOI: 10.20407/fmj.2019-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Development of the autonomic nervous system may play a role in myocardial repolarization lability in infants, but its relationship to repolarization abnormalities remains unclear. Thus, the aim of the present study was to evaluate the relationship between gestational age and ventricular repolarization lability using the variability ratio (VR). METHODS Infants who underwent electrocardiography at a 1-month check-up were included (n=209; 125 males). Gestational age and the following four VR parameters at 1 month of age were compared: VR-I, SDQT/SDRR; VR-II, SDQT/rMSSD; VR-III, SDQTc/SDRR; and VR-IV, SDQTc/rMSSD; where SD, QTc, and rMSSD are standard deviation, QT interval corrected using Fridericia's formula, and root mean square difference of successive RR intervals, respectively. Twenty-eight preterm infants born at <37 weeks of gestation and 181 full-term infants were included. RESULTS Significant correlations were observed between gestational age and VR-I, -III, and -IV (all p<0.05). All VR values were significantly higher in preterm infants compared with full-term infants (I: 0.54 vs 0.48, II: 1.15 vs 0.96, III: 0.88 vs 0.68, IV: 1.59 vs 1.39; median, all p<0.05). CONCLUSION VR assessed at 1 month after birth was impaired in preterm infants, suggesting immaturity of their cardiac autonomic nervous system and ventricular myocardial repolarization.
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Affiliation(s)
- Yuri Mizutani
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan,Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Arisa Kojima
- Department of Pediatrics, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Yuka Takeuchi
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Hirofumi Kusuki
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Keiko Sugimoto
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Keisuke Osakabe
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Naohiro Ichino
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Masayuki Fujino
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Kazuyoshi Saito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Masafumi Miyata
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | | | - Tadayoshi Hata
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan,Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan,Department of Pediatrics, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2106] [Impact Index Per Article: 300.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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Electrocardiographic RR and QT Interval Variability in Patients with Atrial Septal Defect and Healthy Children. Pediatr Cardiol 2017; 38:582-587. [PMID: 28058479 DOI: 10.1007/s00246-016-1551-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 01/19/2023]
Abstract
Atrial septal defect is a common congenital heart disease. In patients with atrial septal defect, left-to-right shunting increases the right atrial and right ventricular preload. This pathological change affects sinus node automaticity and myocardial depolarization and repolarization, and has the potential to evoke arrhythmogenic substrates. We examined the effect of atrial septal defect on sinus node automaticity and myocardial repolarization by investigating the variability in the repolarization interval, namely the QT variability index (QTVI) and variability ratio (VR). This retrospective study included 38 patients (mean age, 2.2 ± 1.9 years; mean left-to-right shunt ratio, 2.1 ± 0.70) and 40 age-matched healthy control subjects evaluated from 2008 to 2015. QTVI was calculated using the ratio of the repolarization parameter variance to heart rate variance, and VR was calculated as the ratio of the standard deviation (SD) of QT intervals to the SD of RR intervals on electrocardiography. There was a significant difference in the SD of all normal RR intervals, heart rate variance, VR, and QTVI of control subjects or patients with low shunt ratio compared with patients with high shunt ratio (all P < 0.05). Linear regression analysis revealed strong positive correlations between the left-to-right shunt ratio and VR (r = 0.662, P < 0.0001) or QTVI (r = 0.808, P < 0.0001). These repolarization indices provide information on alteration of sinus node autonomic control and the pathophysiology of myocardial repolarization, and could be used as a noninvasive indicator of the shunt ratio in children with atrial septal defect.
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Takeuchi Y, Omeki Y, Horio K, Nishio M, Nagata R, Oikawa S, Mizutani Y, Nagatani A, Funamoto Y, Uchida H, Fujino M, Eryu Y, Boda H, Miyata M, Hata T. Relationship between QT and JT peak interval variability in prepubertal children. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28211121 DOI: 10.1111/anec.12444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/28/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The QT variability index (QTVI) is a noninvasive index of repolarization lability that has been applied to subjects with cardiovascular disease. QTVI provides a ratio of normalized QT variability to normalized heart rate variability, and therefore includes an assessment of autonomic nervous activity. However, measurement of QT time is particularly difficult in children, who exhibit physiologically high heart rates compared with adults. In this study, we developed a set of standard values of J-point to Tpeak interval (JTp) for infants by age, and assessed the correlation of QTVI with the JTp variability index (JTpVI). METHODS Subjects included 623 infants and children (0-7 years of age) without heart disease and 57 healthy university students. All subjects were divided into three groups by age. QTVI and JTpVI were calculated based on an electrocardiogram, and age-specific standard values, a gender-specific classification, and a standard growth curve were constructed. RESULTS JTpVI markedly decreased in infancy and slowly decreased thereafter, reaching adult values by school age. There was also a strong correlation of JTpVI with QTVI (r = .856). CONCLUSIONS JTp can be used to evaluate the variability of the repolarization time in healthy infants, and may be useful for detection of early repolarization abnormalities.
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Affiliation(s)
- Yuka Takeuchi
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yumi Omeki
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Kayo Horio
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Miki Nishio
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Rina Nagata
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shota Oikawa
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yuri Mizutani
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Arisa Nagatani
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yuri Funamoto
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hidetoshi Uchida
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masayuki Fujino
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoshihiko Eryu
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroko Boda
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masafumi Miyata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tadayoshi Hata
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
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Variability of Myocardial Repolarization in Pediatric Patients with a Ventricular Septal Defect. Pediatr Cardiol 2016; 37:1458-1464. [PMID: 27554253 DOI: 10.1007/s00246-016-1457-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED In patients with a ventricular septal defect, left-to-right shunting increases the left ventricular preload. This pathological change affects myocardial depolarization and repolarization and has the potential to evoke arrhythmogenic substrates. We examined the effect of ventricular septal defects on myocardial repolarization by investigating the variability in the repolarization interval. This retrospective study included 19 patients (mean age, 1.8 ± 2.1 years) who underwent surgical closure (mean left-to-right shunt ratio, 2.60 ± 0.55) and 26 age-matched healthy controls from 2008 to 2015. Using preoperative electrocardiograms, we studied two electrocardiographic parameters (heart rate-corrected repolarization and variability of repolarization) and four repolarization intervals (QT, JT, J point to T peak [JTp], and T peak to T end [Tp-e] intervals). The variability index (VI) was calculated from the logarithm of the ratio of the repolarization parameter variance to heart rate variance. The various measures were compared between the patients and controls, and significant differences were found in the corrected QT, JTp, and Tp-e intervals (p < 0.05). The VI of the four intervals also showed significant differences (patients vs. CONTROLS QTVI, -0.55 ± 0.61 vs. -1.10 ± 0.53; JTVI, -0.33 ± 0.60 vs. -0.86 ± 0.57; JTpVI, -0.15 ± 0.78 vs. -0.73 ± 0.56; Tp-eVI, 0.75 ± 0.70 vs. 0.11 ± 0.73, respectively; p < 0.05). No correlation was found between the QTVI and corrected QT interval using linear regression analysis. These repolarization characteristics provide not only electrophysiological indices but also a new index with which to assess the pathophysiology of congenital heart disease.
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Baumert M, Porta A, Vos MA, Malik M, Couderc JP, Laguna P, Piccirillo G, Smith GL, Tereshchenko LG, Volders PGA. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. Europace 2016; 18:925-44. [PMID: 26823389 PMCID: PMC4905605 DOI: 10.1093/europace/euv405] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022] Open
Abstract
This consensus guideline discusses the electrocardiographic phenomenon of beat-to-beat QT interval variability (QTV) on surface electrocardiograms. The text covers measurement principles, physiological basis, and clinical value of QTV. Technical considerations include QT interval measurement and the relation between QTV and heart rate variability. Research frontiers of QTV include understanding of QTV physiology, systematic evaluation of the link between QTV and direct measures of neural activity, modelling of the QTV dependence on the variability of other physiological variables, distinction between QTV and general T wave shape variability, and assessing of the QTV utility for guiding therapy. Increased QTV appears to be a risk marker of arrhythmic and cardiovascular death. It remains to be established whether it can guide therapy alone or in combination with other risk factors. QT interval variability has a possible role in non-invasive assessment of tonic sympathetic activity.
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Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marek Malik
- St Paul's Cardiac Electrophysiology, University of London, and National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | - Jean-Philippe Couderc
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Pablo Laguna
- Zaragoza University and CIBER-BBN, Zaragoza, Spain
| | - Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Università 'La Sapienza' Rome, Rome, Italy
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Larisa G Tereshchenko
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Fujino M, Hata T, Kuriki M, Horio K, Uchida H, Eryu Y, Boda H, Miyata M, Yoshikawa T. Inflammation aggravates heterogeneity of ventricular repolarization in children with Kawasaki disease. Pediatr Cardiol 2014; 35:1268-72. [PMID: 24823886 DOI: 10.1007/s00246-014-0926-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/25/2014] [Indexed: 02/07/2023]
Abstract
Kawasaki disease complicates with myocarditis and vasculitis. Even if myocarditis is asymptomatic, heterogeneity of ventricular repolarization may be increased in the acute phase. We evaluated whether the change in repolarization characteristics can be used as a predictor for myocarditis and coronary lesions. Enrolled 34 children who were treated with intravenous immunoglobulin therapy. There were no sequelae in the recovery phase in any subjects, including those who had transient coronary artery lesion. QT and the interval from the Tpeak to Tend (Tp-e) were determined. The Tp-e/QT ratios were compared between the acute and recovery phases and correlations with CRP level and body temperature were evaluated. A retrospective evaluation of Tp-e/QT as predictors of coronary dilation was also performed. Tp-e/QT in the acute phase correlated positively with body temperature and CRP level. In a comparison of patients with and without transient coronary artery lesion, Tp-e/QT was significantly higher in those with dilation. In conclusion, Tp-e/QT was strongly related to transient coronary dilation, in comparison with inflammatory indicators including fever and CRP level.
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Affiliation(s)
- Masayuki Fujino
- Department of Pediatrics, Fujita Health University, Toyoake, Japan,
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9
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Tereshchenko LG, Berger RD. Towards a better understanding of QT interval variability. Ther Adv Drug Saf 2014; 2:245-51. [PMID: 25083216 DOI: 10.1177/2042098611421209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline E14 recommends 'Thorough QT Study' as a standard assessment of drug-induced QT interval prolongation. At the same time, the value of drug-induced QTc prolongation as a surrogate marker for risk of life-threatening polymorphic ventricular tachycardia known as torsades des pointes remains controversial. Beat-to-beat variability of QT interval was recently proposed as an alternative metric. The following review addresses mechanisms of beat-to-beat QT variability, methods of QT interval variability measurements, and its prognostic value in clinical studies.
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Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald D Berger
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 592, 600 N. Wolfe St., Baltimore, MD 21287, USA
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10
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Song BK, Sung K, Cho MJ, Lee HD. QT dispersion in children with Kawasaki disease. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bo-Kyung Song
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Kyoung Sung
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Min-Jung Cho
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Doo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
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Abstract
The QT Variability Index (QTVI) is a non-invasive measure of repolarization lability that has been applied to a wide variety of subjects with cardiovascular disease. It is a ratio of normalized QT variability to normalized heart rate variability, and therefore includes an assessment of autonomic nervous system tone. The approach assesses beat-to-beat variability in the duration of the QT and U wave in conventional surface electrocardiographic recordings, as well as determines the heart rate variability (HRV) from the same recording. As opposed to T wave alternans, QTVI assesses variance in repolarization at all frequencies. Nineteen studies have published data on QTVI in healthy individuals, while 20 have evaluated its performance in cohorts with cardiovascular disease. Six studies have assessed the utility of QTVI in predicting VT/VF, cardiac arrest, or cardiovascular death. A prospective study utilizing QTVI to determine therapy allocation has not been performed, and therefore the final determination of the value of the metric awaits definitive exploration.
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Affiliation(s)
- Craig P Dobson
- Department of Medicine, Division of Cardiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
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Gorczyca D, Postępski J, Olesińska E, Lubieniecka M, Lachór-Motyka I, Opoka-Winiarska V, Gruenpeter A. The clinical profile of Kawasaki disease of children from three Polish centers: a retrospective study. Rheumatol Int 2013; 34:875-80. [PMID: 23893035 PMCID: PMC4028538 DOI: 10.1007/s00296-013-2836-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/16/2013] [Indexed: 01/14/2023]
Abstract
Kawasaki disease (KD) is one of the most common vasculitides of childhood. The aim of this retrospective study is to determine the incidence of KD and to evaluate its presenting symptoms, clinical course, laboratory tests, and treatment in patients with complete KD and incomplete KD at three pediatric rheumatology centers in Poland from January 2011 to December 2012. A total of 27 Caucasian children (12 boys and 15 girls) with median age of 3 years (range 4 months–12 years) were included in this study. The incidence of complete versus incomplete KD was 17 (63 %) versus 10 (37 %) children, respectively. Patients with incomplete KD significantly less presented cervical lymphadenopathy (20 vs. 88.2 %; p = 0.00075), changes in extremities (30 vs. 76.5 %; p = 0.04), and bilateral nonpurulent conjunctivitis (60 vs. 100 %; p = 0.01). Cardiac assessments show that the majority of patients with KD have not got coronary artery aneurysms (CAA). The median time from the onset of symptoms to intravenous immunoglobulin (IVIG) infusion was 7 days for complete KD and 11 days for incomplete KD. IVIG delay in the incomplete KD had no effect on the incidence of CAA. In conclusion, there were no differences in demographic features, age of onset, and laboratory tests of patients with complete and incomplete KD. Patients with incomplete KD significantly rarely presented cervical lymphadenopathy, changes in extremities, and conjunctival injection. Electrocardiography is a sensitive test to recognize cardiac involvement in the acute phase of KD. Despite the fact that incomplete forms of presentation often delay diagnosis, in most patients treatment with IVIG can avoid complication of CAA.
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Affiliation(s)
- Daiva Gorczyca
- 3rd Department and Clinic of Paediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, ul. Koszarowa 5, 51-149, Wrocław, Poland,
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