Oxidative stress in children late after Kawasaki disease: relationship with carotid atherosclerosis and stiffness

Abstract

BackgroundPersistent arterial dysfunction in patients with a history of Kawasaki disease (KD) and an integral role of oxidative stress in the development of cardiovascular disease are increasingly recognized. We sought to test the hypothesis that oxidative stress is increased in KD patients and related to carotid atherosclerotic changes and stiffness.MethodsWe compared the serum levels of oxidative stress biomarkers, carotid intima-media thickness (IMT), and carotid stiffness index among KD patients with coronary aneurysms (n = 32), those without coronary complications (n = 19), and controls (n = 32).ResultsCompared with controls, patients with coronary aneurysms had significantly higher serum levels of malonaldehyde (2.62 ± 0.12 μM vs 2.22 ± 0.07 μM, p = 0.014) and hydroperoxides (26.50 ± 1.13 μM vs 22.50 ± 0.62 μM, p = 0.008). A linear trend of the magnitude of oxidative stress in relation to inflammatory damage was observed for malonaldehyde (p = 0.018) and hydroperoxides (p = 0.014) levels. Serum malonaldehyde and hydroperoxide levels correlated positively with carotid IMT (p < 0.001 and p = 0.034, respectively) and stiffness index (p = 0.001 and p = 0.021, respectively). Multiple linear regression analysis identified serum malonaldehyde level as a significant determinant of carotid IMT (β = 0.31, p = 0.006) and stiffness (β = 0.27, p = 0.008).ConclusionOur findings suggest oxidative stress is increased in KD patients with coronary aneurysms and is associated with carotid intima-media thickening and stiffening.

Diastolic function in children with Kawasaki Disease

“…This concept is supported by studies in animal models demonstrating diastolic dysfunction in early heart transplant rejection [18]. Impaired coronary microvascular function, ongoing low grade inflammation and increased oxidative stress in KD patients late after the acute illness have recently been described [19][20][21].…”

Inhibition of Transforming Growth Factor β Worsens Elastin Degradation in a Murine Model of Kawasaki Disease

“…It is this later constrictive remodeling that accounts for most of the morbidity and mortality from KD, with affected patients at risk for myocardial ischemia and sudden death and often requiring interventions such as balloon angioplasty, coronary bypass, or cardiac transplantation. 54 Interestingly, even patients with KD without a history of CAL have evidence of increased stiffness of the coronary arteries compared with controls 55,56 ; and increased stiffness is observed in association with reduced elastin. 57 In addition, patients with KD have high levels of endothelin-1 and impaired coronary artery vasodilation, suggesting that an imbalance in vasoconstrictive and vasodilatory factors contributes to the disease.…”

Olbrzymi tętniak obejmujący kilka tętnic wieńcowych, w tym pień tętnicy wieńcowej lewej, powodujący objawy ostrego zespołu wieńcowego u 23-letniego chorego: nietypowe powikłanie choroby Kawasaki

“…They showed an increasing frequency of coronary stenosis in patients with coronary aneurysms up to 17 years after the diagnosis. The potential mechanisms underlying these findings include ongoing remodelling of coronary arteries as a result of ongoing inflammation of coronary arteries, demonstrated by higher levels of serum high-sensitivity C-reactive protein and amyloid A [7] and increased oxidative stress [8].…”