Left ventricular systolic function in children with coronary arterial lesion following Kawasaki disease

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Abstract
Seventy-five children with Kawasaki disease underwent quantitative left ventricular cineangiography, and angiographic measurements were made to obtain left ventricular ejection fraction (LVEF) and mean velocity of circumferential fiber shortening (mVcf). In addition, left ventricular pressure and echocardiograms were taken simultaneously before and after nitroprusside infusion using a micromanometer. In the present study, the slope of the line describing end-systolic pressure-diameter relations (E max) was calculated. The 75 children with Kawasaki disease were classified into five groups according to the severity or condition of associated coronary lesions: Grade 0 group (normal — no significant enlargement of the coronary artery is seen), grade 1 group (mild state of lesion — the maximum diameter of the coronary artery is 4.0 mm or less), grade 2 group (moderate state of lesion-the maximum diameter of the coronary artery is 4.0–8.0 mm), grade 3 group (serious state of lesion-the maximum diameter of the coronary artery is 8.0 mm or over, i.e., giant aneurysm), and stenotic lesion (SL) group (myocardial infarction or various other stenotic lesions are involved). Each group was investigated for each index of left ventricular function. In the grade 2 group, the averaged value of LVEF was slightly smaller than those for the grade 0 and 1 groups, while in the grade 3 and SL groups, the averaged values of LVEF were markedly smaller than those for all other groups. Grade 3 and SL groups showed averaged mVcf values that were smaller than those for other groups, while grade 2–3 and SL groups showed averaged values ofE max that were markedly smaller than those for the remaining groups. It is clear from these results thatE max is more sensitive than LVEF or mVcf to left ventricular systolic function and is a useful index for assessment of cardiac function. The LVEF andE max relation showed either hyperbolicity or linearity. The co-ordinate (axes: LVEF and mVcf) indicated a characteristic relationship in position among groups. A further angiographic study was made in 22 patients to follow theirE max changes. It was shown thatE max was elevated or reduced depending upon the grade (severity) of coronary lesions. The results indicate that a large coronary aneurysm associated with Kawasaki disease degrades the left ventricular systolic function and thatE max is the most sensitive index to be used when assessing left ventricular systolic function.