Impact of intravenous immunoglobulin infusion on longitudinal left ventricular performance in patients with acute Kawasaki disease of usual course

• Published in: Journal of cardiology 2009-08, Vol.54 (1), p.45-51
• Main Authors: Koteda, Yusuke, MD, Suda, Kenji, MD, Kishimoto, Shintaro, MD, Ito, Shinichi, MD, Kudo, Yoshiyuki, MD, Nishino, Hiroshi, MD, Ishii, Haruka, MD, Iemura, Motofumi, MD, Matuishi, Toyojiro, MD
• Format: Article
• Language: English
• Subjects: Cardiac function; Cardiovascular; Child, Preschool; Echocardiography; Echocardiography, Doppler; Female; Humans; Immunoglobulin; Immunoglobulins, Intravenous - administration & dosage; Immunoglobulins, Intravenous - pharmacology; Infusions, Intravenous; Kawasaki disease; Male; Mucocutaneous Lymph Node Syndrome - physiopathology; Tissue Doppler; Ventricular Function, Left - physiology
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2009.03.005

Summary Purpose To determine the acute change in cardiac performance after intravenous immunoglobulin infusion (IVIG) in patients with acute Kawasaki disease (KD). Materials and methods Subjects were 33 patients with KD who were treated with IVIG 2 g/kg and recovered without coronary artery lesion and 27 controls. Subjects underwent combined two-dimensional, Doppler, and tissue Doppler echocardiographic (TDI) studies. In KD, these echocardiographic studies were performed before IVIG, 48 h after IVIG, and in convalescence. Echocardiographic variables were compared between KD and controls as well as among 3 time points in KD. Results Before IVIG, KD showed significantly higher peak aortic velocity and shorter aortic ejection time as results of tachycardia and significantly lower E′ ( p < 0.04) but significantly higher E/E′ ( p < 0.02). After IVIG, patients with KD became afebrile and showed significantly lower TDI indices such as S′, E′, and, A′ and isovolumic acceleration (IVA) (163 ± 56 vs. 208 ± 70 cm/s2 , p < 0.01) with higher TDI-derived Tei index (0.50 ± 0.10 vs. 0.44 ± 0.06, p < 0.02) than controls. These differences tended to disappear in convalescence. In analysis of repeated measurements, except for hemodynamic changes associated with tachycardia, S′ (7.9 ± 1.3 vs. 7.0 ± 1.1 vs. 7.4 ± 0.9 cm/s, p < 0.001), IVA (227 ± 72 vs. 163 ± 56 vs. 180 ± 63, p < 0.05), and A′ (7.7 ± 3.0 vs. 5.6 ± 1.3 vs. 6.7 ± 2.3 cm/s, p < 0.001) were significantly different among these time points. Conclusions In patients with acute KD with usual course, IVIG induced transient sub-clinical longitudinal left ventricular dysfunction.