Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease

Left atrial stiffness is in correlation with left atrial reservoir strain in pediatric patients with mitral regurgitation

BACKGROUND

Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR).

OBJECTIVE

To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function.

METHODS

The study included fifty patients (n= 50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis.

RESULTS

Older participants had higher values of the LASI (r= 0.467, p= 0.001). Participants with higher LASI values had a smaller LA reservoir (r= 0.784, p= 0.0001) and smaller LA conduit values (r=-0.374, p= 0.00). Participants with higher LASI values had a larger LA diameter (r= 0.444, p-value= 0.001) and higher average E/e' ratio (r= 0.718, p= 0.0001). There was a significant difference (p= 0.04) in the LASI among participants based on the MR jet area (< 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant.

CONCLUSION

Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR.

Sequential Changes in Left Ventricular Systolic Myocardial Deformation Mechanics in Children with Recurrent Kawasaki Disease

BACKGROUND

Sequential changes in left ventricular (LV) systolic function over time in patients with recurrent episodes of Kawasaki disease (KD) remain unclear.

METHODS

Twenty-five children with recurrent KD were retrospectively studied. Using conventional echocardiographic parameters and myocardial deformation analysis, systolic LV function in children in initial and recurrent KD episodes were compared with separate control groups, comprising 15 controls each. Recurrent KD was defined as occurring at an interval of ≥2 months between the initial and recurrent episodes.

RESULTS

The interval range between initial and recurrent episodes of KD was 3-103 months. In children with KD, 8 (32%) were <1 year of age at the initial episode, 10 (40%) had a recurrence within 1 year of the initial episode, and 4 (16%) and 5 (20%) were intravenous immune globulin nonresponders in initial and recurrent episodes, respectively. In both the initial and recurrent episodes of KD, the mean LV longitudinal peak systolic ε was all within normal range. However, when compared to controls, mean LV longitudinal peak systolic ε was decreased in patients with KD in the acute phases of both the initial and recurrent episodes. When compared to controls, mean LV longitudinal peak systolic ε was decreased in patients with KD in the convalescent phase of the recurrent episodes.

CONCLUSIONS

Subclinical decreases in myocardial systolic deformation, as evidenced by decreased LV longitudinal peak systolic ε, may persist in children in the convalescent phase of recurrent KD; further studies involving larger numbers of patients may be needed for verification.