Affiliation:
1. Department of Pediatrics University of California San Diego School of Medicine La Jolla CA
2. Department of Family Medicine and Public Health University of California San Diego La Jolla CA
3. Rady Children's Hospital San Diego San Diego CA
Abstract
Background
Coronary artery aneurysms and myocarditis are well‐recognized complications of Kawasaki disease (
KD
) but no systematic evaluation of the consequences of myocarditis has been performed in the subset presenting with low ejection fraction (
EF
). We postulated that more severe myocardial inflammation as evidenced by low
EF
during the acute phase could lead to late myocardial fibrosis.
Methods and Results
We measured the carboxyterminal propeptide of procollagen type I (
PIPC
), soluble suppressor of tumorigenicity 2, galectin‐3 (Gal‐3), growth‐differentiation factor‐15, and calprotectin by
ELISA
in late convalescent blood samples from 16
KD
patients who had an
EF
≤55% on their initial echocardiogram. Results were compared with samples from sex‐ and age‐matched
KD
patients with initial
EF
>60%. In the univariate analysis, the median Gal‐3 and
PIPC
levels in the low
EF
group were significantly higher than those in the normal
EF
group (Gal‐3: low
EF
6.216 versus normal
EF
4.976 mg/dL
P
=0.038,
PIPC
: low
EF
427.4 versus normal
EF
265.2 mg/dL,
P
=0.01). In a multivariable analysis, there were significant differences for Gal‐3 and
PIPC
levels between the low and normal
EF
groups, adjusting for age, sex, and worst z score.
Conclusions
Convalescent
KD
patients with a history of low
EF
during the acute illness had significantly elevated levels of Gal‐3 and
PIPC
when compared with matched‐control
KD
patients with normal
EF
. These findings raise concern for myocardial fibrosis as a potential late sequela of the more severe myocarditis experienced by a subset of
KD
patients during the acute phase.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
8 articles.
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