Preliminary Study Of Carotid Artery Elasticity In Acute Kawasaki Disease By Shear Wave Elastography And Ultrafast Pulse Wave Velocity Technology

Objective:To quantitatively evaluate the longitudinal and transverse elastic mo dulus of carotid artery in patients with acute Kawasaki disease（KD）by real-time shea r wave imaging（SWE）and ultrafast pulse wave velocity（UFPWV）technology,and to analyze whether there is vascular dysfunction in the early stage of KD combined with carotid intima-media thickness（IMT）and laboratory indexes,and to explore the predi ctive effectiveness of carotid elastic parameters in coronary artery disease of KD.Methods:50 children with KD diagnosed in the Department of Pediatric Cardio logy of Gansu Children’s Hospital from December 2020 to December 2021 were selec ted as KD group,and subdivided into coronary artery dilatation group（CAD group）an d non-dilated coronary artery group（NCAD group）according to the results of echocar diography.At the same time,40 patients with age and sex matched with heart murmur but normal echocardiography were selected as normal control group（N group）.The ge neral clinical data and laboratory biochemical indexes of all subjects were collected,a nd the IMT of left carotid artery was measured by high frequency two-dimensional ult rasound.SWE and UFPWV techniques were used to scan the left carotid artery,and th e longitudinal elasticity（EMmax,EMmin,EMmean）and transverse elasticity beginni ng of the systole（PWV-BS）and ending ofthe systole（PWV-ES）pulse wave velocity o f carotid artery were obtained.Thedifferences of general clinical data and laboratory in dexes between group N and group KD（with or without CAD）were compared,the diff erences of morphological structure and elastic function parameters of carotid artery am ong groups were analyzed,and the correlation between laboratory indexes and EMme an,PWV-BS,PWV-ES and IMT was analyzed to explore whether acute KD was acco mpanied by changes of vascular function.The receiver operating characteristic curve（ROC）was drawn to determine the sensitivity,specificity and optimal cut-off value of carotid artery a-EMmean,p-EMmean,PWV-BS and PWV-ES for early prediction of c oronary artery disease in KD.Results:There were significant differences in body temperature,respiration and pulse among the three groups（all P=0.000）,and there were overall differences in labo ratory indexes such as Na,ALT,ALB,GLO,A/G,HDL,NE,NLR,WBC,CRP,ESR a nd HGB among the three groups（P=0.000）,but there were no significant differences i n the above indexes between CAD group and NCAD group.There were significant dif ferences in echocardiographic indexes such as LMCA,RCA,LAD,LMCAZ-score,R CAZ-score,LADZ-score and LVDd among the three groups(overall P_{LMCA,LAD,LMCAZ-score,RCAZ-score,LADZ-score,LVDd}=0.000).The values of IMT,longitudinal elasticity（EMma x,EMmin,EMmean）and transverse elasticity（PWV-BS,PWV-ES）of carotid artery i n CAD group were higher than those in NCAD group and N group（all P=0.000）.The values of carotid IMT,longitudinal elasticity（EMmax,EMmin,EMmean）and transv erse elasticity（PWV-BS,PWV-ES）in NCAD group were significantly higher than tho se in N group（P<0.05）.Carotid IMT,EMmean,PWV-BS,PWV-ES were negatively c orrelated with HDL-C,carotid IMT was positively correlated with a-EMmean,p-EMm ean,PWV-BS and PWV-ES（r=0.586,0.622,0.584,0.560,P=0.000）,carotid a-EMme an and p-EMmean was positively correlated with PWV-BS and PWV-ES（r_a=0.656,0.642,r_p=0.695,0.622,all P=0.000）.ROC curve analysis showed that the areas under th e curve of SWE（a-EMmean,p-EMmean）and UFPWV（PWV-ES,PWV-BS）for dia gnostic CAD were 0.923,0.916,0.872 and 0.901 respectively,and the 95%confidenc e intervals were（0.847-0.968）,（0.839-0.964）,（0.785-0.954）and（0.820-0.933）,respec tively,and the best cut-off values were 8.5k Pa,8.2k Pa,4.15m/s and 4.13m/s,respectiv ely.The sensitivity was 96.7%,90.00%,80.00%and 80.00%respectively,and the spe cificity was 76.7%,76.7%,91.70%and 91.70%respectively.The Yoden index was 0.733,0.667,0.717 and 0.717 respectively.The longitudinal average Young’s modulus an d UFPWV transverse Young’s modulus had good sensitivity and specificity in the diag nosis of CAD.Conclusion:No matter whether the coronary artery is dilated or not,the change s of carotid artery wall structure（IMT thickening）and vascular wall function（longitud inal and transverse elasticity value increase）in patients with acute KD suggest that vas cular function damage already exists in the early stage of KD.The parameters of SWE and UFPWV can better reflect the changes of vascular microstructure and function in the early stage of KD,and can be used as a new imaging index for non-invasive and ac curate quantitative evaluation of vascular functional lesions in KD,and can early predi ct coronary artery disease in KD.