Echocardiographic and electrocardiographic trends in children with acute Kawasaki disease.
BACKGROUND
Kawasaki disease (KD), while primarily an acute, self-limited, multisystem vasculitis, is more appropriately described as a pancarditis, from a cardiac perspective. Many patients are noted to have ventricular dilation on initial echocardiography; however, functional and structural measurements may remain within the normal range.


OBJECTIVE
The authors sought to determine echocardiographic and electrocardiographic trends after acute KD.


METHODS
Clinical data were reviewed on all patients presenting with acute KD to the Hospital for Sick Children (Toronto, Ontario). Patients with at least three electrocardiograms and echocardiograms over the first year post-KD were eligible. Mixed linear regression analysis for repeated measures was used to determine trends over time and associated factors.


RESULTS
One hundred seventy-six eligible patients were reviewed. Mean initial coronary artery diameter Z-scores were increased, with 4% having aneurysms. The mean (+/- SD) initial Z-score of ejection fraction was 0.40+/-0.84 (P<0.001 versus normal) and left ventricular end-diastolic dimension (LVED) was 0.97+/-0.98 (P<0.001 versus normal). The initial mean QT dispersion was 54+/-23 ms (P<0.001 versus normal). Mixed linear regression analysis for repeated measures demonstrated that the LVED Z-score decreased significantly over time, and a greater Z-score was independently associated with a greater initial LVED Z-score. Increased QT dispersion was only related to higher initial dispersion, with no trend over time.


CONCLUSIONS
While systolic ventricular dysfunction may not be evident, subclinical myocardial involvement may be indicated by subtle ventricular dilation and repolarization abnormalities.
Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada.
Matthew A
MA
Crystal
Sumeet K
SK
Syan
Rae S M
RS
Yeung
Anne I
AI
Dipchand
Brian W
BW
McCrindle
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D011379:Prognosis; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology