Top

Published in:

01-08-2014 | Original Article

Evaluation of echogenicity of the heart in Kawasaki disease

Authors: Hazumu Nagata, Kenichiro Yamamura, Kiyoshi Uike, Yasutaka Nakashima, Yuichiro Hirata, Eiji Morihana, Yumi Mizuno, Shiro Ishikawa, Toshiro Hara

Published in: European Journal of Pediatrics | Issue 8/2014

Abstract

Pathologic studies of the heart in patients with Kawasaki disease (KD) revealed vasculitis, valvulitis, myocarditis, and pericarditis. However, there have been no studies on the quantitative determination of multi-site echogenicity of the heart in KD patients. It is also undetermined whether the degree of echogenicity of each site of the heart in patients with KD might be related to the response to intravenous immunoglobulin (IVIG) treatment. In 81 KD patients and 30 control subjects, we prospectively analyzed echogenicity of the heart. Echogenicity was measured in four sites: coronary artery wall (CAW), mitral valve (MV), papillary muscle (PM), and ascending aortic wall (AAo wall) by the calibrated integrated backscatters (cIBs). The cIB values of all measurement sites at acute phase in KD patients were significantly higher than those in control subjects (KD patients vs control subjects; CAW, 19.8 ± 6.2 dB vs 14.5 ± 2.0 dB, p < 0.05; MV, 23.3 ± 5.3 dB vs 16.0 ± 3.3 dB, p < 0.05; PM, 22.4 ± 5.1 dB vs 12.7 ± 1.9 dB, p < 0.05; AAo wall, 25.3 ± 5.6 dB vs 18.3 ± 3.4 dB, p < 0.05). The cIB values of CAW at the acute phase in IVIG nonresponders were significantly higher than those in responders. Conclusion: Echogenicity of the heart in KD patients at the acute phase increased not only in the coronary artery wall but also in other parts of the heart. Echogenicity of CAW might be helpful in determining the unresponsiveness of IVIG treatment.

Available only for authorised users

Abe O, Karasawa K, Hirano M, Miyashita M, Taniguchi K, Ayusawa M, Sumitomo N, Okada T, Harada K, Mugishima H (2010) Quantitative evaluation of coronary artery wall echogenicity by integrated backscatter analysis in Kawasaki disease. J Am Soc Echocardiogr 23:938–942PubMedCrossRef

Egami K, Muta H, Ishii M, Suda K, Sugahara Y, Iemura M, Matsuishi T (2006) Prediction of resistance to intravenous immunoglobulin treatment in patients with Kawasaki disease. J Pediatr 149:237–240PubMedCrossRef

Fujiwara H, Hamashima Y (1978) Pathology of the heart in Kawasaki disease. Pediatrics 61:100–107PubMed

Harada M, Yokouchi Y, Oharaseki T, Matsui K, Tobayama H, Tanaka N, Akimoto K, Takahashi K, Kishiro M, Shimizu T (2012) Histopathological characteristics of myocarditis in acute-phase Kawasaki disease. Histopathology 61:1156–1167PubMedCrossRef

Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R (1996) Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 94:1379–1385PubMedCrossRef

Kim T, Choi W, Woo CW, Choi B, Lee J, Lee K, Son C, Lee J (2007) Predictive risk factors for coronary artery abnormalities in Kawasaki disease. Eur J Pediatr 166:565–571CrossRef

Kobayashi T, Inoue Y, Takeuchi K, Okada Y, Tamura K, Tomomasa T, Morikawa A (2006) Prediction of intravenous immunoglobulin unresponsiveness in patients with Kawasaki disease. Circulation 113:2606–2612PubMedCrossRef

Leonardi B, Giglio V, Sanders SP, Pasceri V, De Zorzi A (2010) Ultrasound tissue characterization of the myocardium in patients after Kawasaki disease. Pediatr Cardiol 31:766–772PubMedCrossRef

Lieback E, Hardouin I, Meyer R, Bellach J, Hetzer R (1996) Clinical value of echocardiographic tissue characterization in the diagnosis of myocarditis. Eur Heart J 17:135–142PubMedCrossRef

10.

Muta H, Ishii M, Furui J, Nakamura Y, Matsuishi T (2006) Risk factors associated with the need for additional intravenous gamma-globulin therapy for Kawasaki disease. Acta Paediatr 95:189–193PubMedCrossRef

11.

Nakano H, Nojima K, Saito A, Ueda K (1985) High incidence of aortic regurgitation following Kawasaki disease. J Pediatr 107:59–63PubMedCrossRef

12.

Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110:2747–2771PubMedCrossRef

13.

Nishio H, Kanno S, Onoyama S, Ikeda K, Tanaka T, Kusuhara K, Fujimoto Y, Fukase K, Sueishi K, Hara T (2011) Nod1 ligands induce site-specific vascular inflammation. Arterioscler Thromb Vasc Biol 31:1093–1099PubMedCrossRef

14.

Omi W, Nagai H, Takata S, Yuasa T, Sakagami S, Kobayashi K (2002) Ultrasonic tissue characterization in acute myocarditis: a case report. Circ J 66:416–418PubMedCrossRef

15.

Park SH, Chung JW, Lee JW, Han MH, Park JH (2001) Carotid artery involvement in Takayasu's arteritis: evaluation of the activity by ultrasonography. J Ultrasound Med 20:371–378PubMed

16.

Takeuchi D, Saji T, Takatsuki S, Fujiwara M (2007) Abnormal tissue doppler images are associated with elevated plasma brain natriuretic peptide and increased oxidative stress in acute Kawasaki disease. Circ J 71:357–362PubMedCrossRef

17.

Tomita H, Sawada Y, Higashidate Y, Chiba S, Ito S, Kogasaka R (1990) Mitral regurgitation with gross deformity of a mitral leaflet due to Kawasaki disease. Pediatr Cardiol 11:153–155PubMedCrossRef

18.

Warsame TA, Keen OE, Mookadam F, Chaliki HP (2009) Liquefaction necrosis of calcified mitral annulus. Echocardiography 26:1082–1083PubMedCrossRef

19.

Weber HS, Myers JL (1994) Maternal collagen vascular disease associated with fetal heart block and degenerative changes of the atrioventricular valves. Pediatr Cardiol 15:204–206PubMedCrossRef

20.

Yu JJ, Jang WS, Ko HK, Han MK, Kim YH, Ko JK, Park IS (2011) Perivascular brightness of coronary arteries in Kawasaki disease. J Pediatr 159(454–457):e1PubMed

Title: Evaluation of echogenicity of the heart in Kawasaki disease
Authors: Hazumu Nagata
Kenichiro Yamamura
Kiyoshi Uike
Yasutaka Nakashima
Yuichiro Hirata
Eiji Morihana
Yumi Mizuno
Shiro Ishikawa
Toshiro Hara
Publication date: 01-08-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 8/2014
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-014-2296-4

At a glance: The STEP trials

Springer Medicine

Evaluation of echogenicity of the heart in Kawasaki disease

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2014

A case of Fabry nephropathy with histological features of oligonephropathy

Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux

Urinary tract infection in small outpatient children: the influence of age and gender on resistance to oral antimicrobials

Impact of health care providers’ advice on vaccine refusal for children with an acute nervous system infection

Thymic size correlates with cord blood zinc levels in low-birth-weight newborns

Successful treatment of metastatic βHCG-secreting germ cell tumor occurring 3 years after total resection of a pineal mature teratoma