Evaluation of Myocardial Function by Tissue Doppler Imaging in Children with Kawasaki Disease

Abstract

PURPOSE: The objective of this study was to assess myocardial function before and after IVIG treatment by tissue Doppler imaging in children with Kawasaki disease. METHODS: This study was conducted on 43 patients with Kawasaki disease from April 2005 to February 2006 at Dongsan Medical Center, Keimyung University. Myocardial function of all patients was examined using echocardiography before (time 1) and after intravenous gamma-globulin (IVGG, time 2) treatment. Deceleration time (DT), isovolumic relaxation time (IVRT), fractional shortening (FS), and peak early diastolic (E), peak late diastolic (A) velocity of transmitral flow were measured by M-mode and pulsed wave Doppler. Systolic (Sm), peak early diastolic (Em), peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by tissue Doppler imaging. The author calculated modified Tei index, E/A, E/Em ratio by using measured values. RESULTS: Forty three patients were 27 boys and 16 girls. The average age of patients was 3 years and 1 month. There was 5 patients treated IVGG more than twice and no patient with definite coronary dilatation. All conventional Doppler parameters showed no significant difference statistically between control and time 1, 2. Among tissue Doppler parameters measured at time 2 in comparison to control and time 1, modified Tei index in septum, E/Em and modified Tei index in inferior wall decreased significantly and Am in inferior wall increased significantly. CONCLUSION: Although the results did not show consistency throughout all measured areas, it showed significant difference between patients and control in some areas' myocardiac function in relative recovery phase. This results are thought that the change in myocardial function may be derived from the Kawasaki disease during acute phase and recovery phase. There should be more investigations both in number and in diversity of patients with Kawasaki disease and there also should be studies to find how the changes mentioned above are different from persistent febrile group without the Kawasaki disease and whether they are temporal changes in the acute phase due to IVIG volumic overload.