Arterial Hemodynamics in Patients After Kawasaki Disease

Abstract

Background-Histopathological findings in the acute stage of Kawasaki disease (KD) indicate widespread vascular inflammation that involves not only coronary arteries but also systemic arteries. This may cause changes in systemic arterial wall properties after KD, which could have adverse effects on arterial hemodynamics (an important predictor of cardiovascular morbidity and mortality). Methods and Results-Systemic arterial hemodynamics were investigated by measuring aortic input impedance during cardiac catheterization in 42 KD patients who had developed coronary artery lesions (CALs) in the acute stage of KD. The KD patients were subdivided into 2 groups according to the angiographic findings (group 1A, 26 patients with persistent CALs; group 1B, 16 patients with regressed CALs), and results were compared with those of 36 referents (group 2). Compared with referents, characteristic impedance was significantly higher for KD patients (137.0Ϯ5.1, 125.7Ϯ8.2, and 97.9Ϯ4.1 dyne · s · cm Ϫ5 · m 2 for group 1A, group 1B, and group 2, respectively), and total peripheral arterial compliance indexed to age-specific values was significantly lower for KD patients (group 1A 72.9Ϯ4.2% of normal; group 1B 70.6Ϯ5.9% of normal; group 2 97.7Ϯ4.0% of normal; for both variables, PϽ0.05 for each KD group versus group 2; PϭNS between KD groups), which suggests that both central and peripheral arterial wall stiffness increase after KD regardless of persistence of CALs. Also, indices of arterial wave reflection (reflection coefficient, reflection factor, and augmentation index) were all significantly higher in KD patients than in referents (PϽ0.05), with the result that the aortic pressure waveforms of the present KD patients resembled those generally observed in the elderly. In addition, levels of circulating markers of endothelial dysfunction (ACE and von Willebrand factor) were associated with increased vascular stiffening in KD patients but not in referents. Conclusions-These results indicating abnormal arterial hemodynamics after KD highlight the importance of regular monitoring of the systemic arterial bed and potentially relevant cardiovascular events in long-term follow-up of KD.

The arterial reservoir pressure increases with aging and is the major determinant of the aortic augmentation index

“…While such discrete reflections do occur and may have substantial magnitude locally, the arrangement of the arterial tree markedly attenuates the backward travel of waves such that a limited amount of reflection is evident in the proximal aorta once the arterial reservoir is accounted for (30, 33, 35). In this regard, our observations are consistent with a previous invasive study of healthy children (27) and other studies in anesthetized dogs (16). …”

Pathophysiology of Pulmonary Circulation in Congenital Heart Disease

“…The pulmonary vascular bed also has many bifurcations with caliber changes. In this type of system, blood flow and pressure waves produce reflections at the site of a bifurcation or vessel caliber change [1,2]. Therefore, the measured pressure or flow we observe is the sum of forward and reflected waves, and thus augmentation of reflected waves causes significant pressure elevation (Fig.…”

Carotid Intima-Media Thickness and Pulse Wave Velocity After Recovery From Kawasaki Disease

“…Senzaki et al23) reported that there is an a characteristic increase in impedence, a decrease in total peripheral arterial compliance, and an increase arterial wave reflexion, regardless of the presence of coronary artery lesions in patients with KD. It has also been reported that there is stiffness of the aorta, carotid artery, and brachio-radial artery in the late stage in children who have a history of KD 24-26).…”

“…Even in patients who have no coronary lesions, such findings as a pre-atherosclerotic lipid profile,26) endothelial function,23) systemic arterial stiffness24) and increased cIMT are observed.…”