Tissue Doppler Imaging as a Predictor of Immunoglobulin Resistance in Kawasaki Disease

Abstract

Kawasaki disease (KD) is characterized by myocarditis and left ventricular dysfunction during the acute phase of the illness. Despite treatment with intravenous immunoglobulin (IVIG), a significant number of patients are IVIG resistant. We evaluated KD patients in the acute phase of illness using tissue Doppler imaging (TDI) to assess whether myocardial dysfunction may predict IVIG resistance. All patients with acute KD presenting to Children's Hospital Colorado from February 2007 through March 2014 were included in this study and underwent echocardiograms with TDI evaluation at diagnosis. Patients were divided into two groups: IVIG resistant and IVIG responder. Group differences were assessed using Wilcoxon-Mann-Whitney and Chi-square testing. Receiver operating characteristic (ROC) curve analysis was utilized to determine threshold values of TDI measurements associated with IVIG resistance. Fifty-one age-matched IVIG resistant patients were compared to 51 IVIG responder patients [median age, IQR 44.57 (20.13-77.07) vs. 33.49 (17.30-62.89) months, p < 0.44]. There were significant differences in the septal and mitral early diastolic velocities (E') (p < 0.001 and p < 0.01), respectively. ROC analysis demonstrated that tricuspid E' <0.15 cm/s, septal E' <0.12 cm/s, and mitral E' <0.16 cm/s were good predictors of IVIG unresponsiveness (AUC = 0.66, 0.66, and 0.70, respectively). There were no differences between the systolic velocities and late diastolic velocities (A'). IVIG resistant KD patients present with significantly greater diastolic dysfunction compared to responders in patients with KD. TDI may be a useful tool to differentiate KD patients at higher risk of IVIG resistance.

Losartan attenuates the coronary perivasculitis through its local and systemic anti-inflammatory properties in a murine model of Kawasaki disease

“…Losartan in addition to IVIG suppressed the incidence of the myocarditis. In human, myocarditis and left ventricular dysfunction during acute phase of KD is a predictor of IVIG resistance (18). Thus, our results potentially support that losartan may improve cardiac function by suppressing myocarditis in patients with IVIG-resistant KD.…”

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

“…Another additional explanation for the similar LV longitudinal peak systolic ε in recurrent KD and controls may be the small number of children with CALs or IVIG nonresponders, factors that have been associated with decreased LV function. 23) 24) Moreover, as treatment with IVIG has been associated with accelerated recovery of LV function 3) and since all children with KD in our study received IVIG, we could speculate that the decreased LV function caused by myocarditis from repeated recurrences of KD recovered with IVIG treatment.…”

Characteristics of admissions for Kawasaki Disease from 1997 to 2012: Lessons from a national database

“…[15] However, previous literature has demonstrated that African Americans have higher rates of IVIG resistance. [19][20][21] Patients that have IVIG resistance, defined as persistence of fevers after the first dose of IVIG, have been shown to have an increased risk of developing coronary artery abnormalities. [22,23] Further research is needed to determine if racial differences in IVIG resistance have an implication on the development of coronary artery aneurysms.…”