Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease.
Noncoronary cardiac abnormalities are associated with coronary artery dilation and with laboratory inflammatory markers in acute Kawasaki disease.
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DOI：
10.1016/j.jacc.2010.08.619
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发表时间：
2011-01-04
影响因子：
24
通讯作者：
Colan, Steven D
中科院分区：
文献类型：
--
作者：
Printz, Beth F;Sleeper, Lynn A;Newburger, Jane W;Minich, L LuAnn;Bradley, Timothy;Cohen, Meryl S;Frank, Deborah;Li, Jennifer S;Margossian, Renee;Shirali, Girish;Takahashi, Masato;Colan, Steven D
我们探讨了川崎病 (KD) 诊断后早期非冠状动脉心脏异常与冠状动脉扩张以及实验室炎症标志物的关系。诊断后早期就会出现左心室（LV）功能障碍、二尖瓣反流（MR）和主动脉根部扩张；它们与冠状动脉扩张和炎症标志物的关系尚未得到很好的描述。在美国国立卫生研究院资助的儿科心脏网络 KD 脉冲类固醇试验中，198 名受试者在 KD 诊断时以及诊断后 1 周和 5 周获得了集中解读的超声心动图。构建回归模型来研究早期左室功能障碍、MR 和主动脉根部扩张与冠状动脉扩张和实验室炎症标志物之间的关系。诊断时，20% 的受试者存在左心室收缩功能障碍，并与 29% 的受试者中的冠状动脉扩张相关 (p = 0.004)。尽管左室功能障碍迅速改善，但诊断时的左室功能障碍预测诊断后 1 周和 5 周冠状动脉扩张的可能性更大（5 周优势比：2.7，95% 置信区间：1.2 至 6.3）。诊断时，27% 的受试者存在 MR，8% 的受试者存在主动脉根部扩张；每一个都与诊断时较大的冠状动脉尺寸相关。左心室功能障碍与较高的红细胞沉降率相关，并且仅在诊断时与较低的血清白蛋白相关； MR 始终与较高的红细胞沉降率和较低的白蛋白相关。主动脉根部大小与炎症标志物几乎没有关联。非冠状动脉心脏异常与川崎病后前 5 周内的冠状动脉扩张和炎症实验室证据相关，表明存在共同的炎症机制。 （川崎病脉冲类固醇治疗试验[小儿心脏网络进行的试验]；NCT00132080）
We explored the association of noncoronary cardiac abnormalities with coronary artery dilation and with laboratory inflammatory markers early after Kawasaki disease (KD) diagnosis. Left ventricular (LV) dysfunction, mitral regurgitation (MR), and aortic root dilation occur early after diagnosis; their associations with coronary artery dilation and inflammatory markers have not been well-described. Centrally interpreted echocardiograms were obtained at KD diagnosis and 1 and 5 weeks after diagnosis on 198 subjects in the National Institutes of Health-sponsored Pediatric Heart Network KD pulsed steroid trial. Regression models were constructed to investigate the relationships among early LV dysfunction, MR, and aortic root dilation with coronary artery dilation and laboratory inflammatory markers. At diagnosis, LV systolic dysfunction was present in 20% of subjects and was associated with coronary artery dilation, seen in 29% (p = 0.004). Although LV dysfunction improved rapidly, LV dysfunction at diagnosis predicted greater odds of coronary artery dilation at 1 and 5 weeks after diagnosis (5-week odds ratio: 2.7, 95% confidence interval: 1.2 to 6.3). At diagnosis, MR was present in 27% of subjects and aortic root dilation was present in 8%; each was associated with larger coronary artery size at diagnosis. Left ventricular dysfunction was associated with higher erythrocyte sedimentation rate and, at diagnosis only, lower serum albumin; MR was associated with higher erythrocyte sedimentation rate and lower albumin at all times. Aortic root size had little association with inflammatory markers. Noncoronary cardiac abnormalities are associated with coronary artery dilation and laboratory evidence of inflammation in the first 5 weeks after KD, suggesting a shared inflammatory mechanism. (Trial of Pulse Steroid Therapy in Kawasaki Disease [A Trial Conducted by the Pediatric Heart Network]; NCT00132080)