Cardiac biomarkers for early detection of cardiac involvement in children with Kawasaki disease: a cross-sectional study

Abstract

Background Kawasaki disease (KD), which is the second most prevalent vasculitis disease in children after IgA vasculitis, can cause serious cardiovascular complications. Early detection of cardiac involvement in KD is an essential part in managing and preventing the cardiac sequels. Although some cardiac biomarkers such as cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have recently been suggested for early diagnosis of cardiac involvement in patients with KD, their applicability is still unclear. Thus, this study aimed to compare the levels of cTnI and NT-proBNP in KD child patients with or without cardiac involvement. Methods In this cross sectional study, 32 children with KD who were admitted to the children teaching hospital of Tabriz University of Medical Sciences between April 2015 and April 2018, were consecutively included in the study. For all involved children, the coronary artery involvement defined as coronary artery aneurysm or perivascular brightness of coronary arteries was examined by transthoracic echocardiography, and their serum levels of NT-proBNP and cTnI were measured. Results Of 32 enrolled patients, 4 (9.4%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and 1 patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 and the NT-proBNP assessments revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p-value, 0.001). ROC analysis for power of the NT-proBNP in predicting the cardiac involvement, revealed an excellent power for NT-proBNP (AUC=1.000, p=0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent. Conclusion Unlike the cTnI, the NT-proBNP can serve as an excellent objective test for early detection of cardiac involvement. Therefore, in KD-patients with high levels of NT-proBNP additional therapy and closer follow up should be considered.

Society for Cardiovascular Magnetic Resonance 2022 Cases of SCMR case series

“…Although COVID-19 is demonstrated to be less severe in children compared to adults, the reports of some devastating and fatal complications following COVID-19 in children and adolescents have generated considerable concern and the number of such reports is rapidly increasing [4] . Kawasaki disease (mucocutaneous lymph node syndrome) is characterized as the most common cause of coronary artery aneurysms in children [5] , [6] , [7] . Several studies have reported a Kawasaki-like illness following COVID-19 called MIS-C [8] , [9] , [10] .…”