Long-term evaluation of endothelial function in Kawasaki disease patients

Abstract

Background: Kawasaki disease is an acute systemic vasculitis. Cardiac complications are frequent and include endothelial dysfunction in patients with coronary anomalies. So far, the presence of endothelial dysfunction in patients with no coronary lesions has not been demonstrated. Peripheral arterial tonometry (Endo-PAT) measures the microvascular function in response to local ischaemia and has been validated in adult population, but its use in children is scarce. Aim: To evaluate endothelial dysfunction in children as a long-term complication after Kawasaki disease using Endo-PAT. Methods: We evaluated two groups of subjects: (1) Kawasaki disease patients over 11 years of age, diagnosed for .5 years, with no coronary lesions, or any other risk factors for cardiovascular disease; (2) control group of individuals without cardiovascular risk factors. Patients and controls were clinically accessed. Endo-PAT was performed to determine reactive hyperaemia index and augmentation index. Results: A total of 35 individuals (21 males, age 21 6 6 years) were evaluated (group 1: 19; controls: 16). Kawasaki disease patients presented significant lower reactive hyperaemia index (1.68 6 0.49 versus 2.31 6 0.53; p 5 0.001). Augmentation index was similar in both groups (210 6 7 versus 211 6 5; p . 0.005). Most patients with Kawasaki disease disclosed endothelial dysfunction (68%) compared with only 12% in controls. Conclusions: Endo-PAT is feasible and reproducible in the child population. Endothelial dysfunction is a frequent long-term complication in patients after Kawasaki disease with normal appearing coronary arteries. However, these results need validation in a larger population.

Myocardial fibrosis after adrenergic stimulation as a long-term sequela in a mouse model of Kawasaki disease vasculitis

“…Several studies have reported that coronary microvascular circulation can be impaired in KD patients, even in the absence of coronary artery involvement (58)(59)(60). KD patients also exhibit generalized abnormalities in endothelial cell function (61)(62)(63) and myocardial flow reserve (60,63) that may persist for several years. However, the long-term risk and adverse effects of endothelial cell dysfunction after acute KD are controversial due to conflicting reports showing either the presence (61)(62)(63) or the absence (64-66) of long-term persistence of endothelial cells abnormalities.…”

“…KD patients also exhibit generalized abnormalities in endothelial cell function (61)(62)(63) and myocardial flow reserve (60,63) that may persist for several years. However, the long-term risk and adverse effects of endothelial cell dysfunction after acute KD are controversial due to conflicting reports showing either the presence (61)(62)(63) or the absence (64-66) of long-term persistence of endothelial cells abnormalities. In line with this, a recent post hoc analysis of an international multicenter trial reported defective exercise-induced myocardial perfusion late after acute KD in 16.5%-22% of patients both with and without CAAs (67).…”

Kawasaki disease and cardiovascular risk: a comprehensive review of subclinical vascular changes in the longer term

“…The oldest patient was 41 years of age and the longest time elapsed after the acute illness was 34 years . One study detected significant differences , whereas two others did not . As with all measures of endothelial function, environmental (ambient temperature, time of the day) and participant (food and alcohol intake, speaking, sleeping, position, and white coat effect) factors may affect results .…”

Vascular function long term after Kawasaki disease: another piece of the puzzle?

“…It has been demonstrated that lower Endo-PAT index is associated with increased cardiovascular risk. [37][38][39][40] The participants rested in the supine position with both hands at the same level. Specific finger probes for recording pulse amplitude volume curves were placed on the index finger of each hand, and a blood pressure cuff was placed on the non-dominant upper arm (study arm), whereas the other arm served as a the control (control arm).…”