Assessment Of Left Ventricular Function In Children With Kawasaki Disease By VSI,RT3DE

Objective: Evaluate the left ventricular systolic function of children with Kawasaki disease before and after treatment and its clinical significance by application of Vector myocardial strain and strain rate imaging (VSI) and Real-time Three-dimensional Echocardiography (RT-3DE).Methods: Detect 32 cases of children diagnosed as Kawasaki disease or incomplete KD before treatment (B1 group), one month after treatment (B2 group) and 30 cases of age-matched normal children (N group) by MayLab 30 and Philips iE33 with VSI and RT3DE Technology. The children with KD had been in hospital from March in 2008 to December in 2008, all cases were clinically diagnosed in line with the standard and treated with gamma globulin.The control group had no clinical manifestations of Kawasaki disease, blood and biochemical examination, electrocardiogram and echocardiography results were normal.â‘ Using of Mylab30 ultrasound imaging machine: subjects from the left decubitus, breath calmly and are connected ECG. Choose the clear left ventricular long axis M-mode ultrasound image, start VSI mode and select a clear parasternal short axis view at two sharp valve level, papillary muscle level and the level of near apex. The apical four-chamber view, the left two-chamber view and long axis view is also collected. Collect dynamic two-dimensional gray-scale image in three consecutive cardiac cycle,store it . Analysis it off-line, record the Velocity, Strain and Strain rate of each point.â‘¡Using Philips IE33 ultrasound imaging: supine subjects from the left decubitus, breath calmly and are connected ECG. Switch the probe to the X3-1. Sellect the standard apical four chamber view to obtain a clear two-dimensional images, start"FullVolume"imaging key. A complete left ventricular endocardium is included in the sampling box. Ask the subjects to hold their breath. Collect images to store in hard disk devices. Analysis three-dimensional image with application of Qlab software, the overall and segmental volume-time curve is showed. Record the overall EF(3D-LVEF), the value of EDV% of 17 end-systolic segments. Children with Kawasaki disease before and after treatment are detected as all the above methods.Results:1. VSI: The law of waveform in myocardial velocity-time curve in normal children, strain rate-time curve, circumferential direction of velocity-time curve is clearly showed. The curve in children with Kawasaki disease is disorder with disappeared wave characteristics and badly showed the peak. The compared results of Systolic peak of the curve are as follows:â‘ Longitudinal peak systolic velocity (Vs) of almost all left ventricular wall basal segment in the B1 group is lower than that in the N group or significantly lower than that in the N group; Vs of the majority left ventricular wall basal segment in the B2 group is higher than that in the B1 group, but it is still lower than that in the N group.â‘¡Longitudinal and radial peak systolic strain rate, circumferential peak systolic velocity of the majority of left ventricular segment in the B1 group ,comparing with that in N group, is reduced or significantly reduced; Longitudinal part and radial peak systolic strain rate, circumferential peak systolic velocity of some left ventricular segments in the B2 group is higher than that in B1 group, but it is still lower than that in N group for a small number of segments.2. RT-3DE:â‘ Left ventricular overall ejection fraction (3D-LVEF) in B1 group is significantly lower than that in the N group; 3D-LVEF in B2 group is higher than that in the B1 group, but it is still lower than that in the N group.â‘¡EDV% of 7,3,16 segment in B1 group is increased ,comparing with that in the N group. EDV% of 1,5,6,8,11,12 segment is significantly increased; EDV% of the majority of all segments in B2 group is lower than that in the B1 group. Compared with which in the N group, EDV% of 6, 12 segment in B2 group is higher,. EDV%-time curve for normal control group of children is regular, the value of segmental EDV% at end-systolic minimum almost at the same time. Compered with the control group, Segmental EDV%-time curve for B1 group, B2 group is not regular. It is variable for the end-systolic volume of the smallest time. 3. There is no statistically significant difference between the value of LVEF among three groups. The value of LVEF is detected by Simpson method from two-dimensional echocardiography.Conclusion: Injuration of overall and ragional myocardial systolic-fuction is possible for children with Kawasaki disease before and after treatment, for which there is a marked improvement after treatment. Although, a small number of segmental myocardial contractile function is not recovered. VSI and RT-3DE technolgy is superior to two-dimensional echocardiography at testing the overall and ragional myocardial systolic-fuction. The evaluation of overall and regional systolic left ventricular function of children with Kawasaki disease before and after treatment can be more accurately and more effective, more comprehensive as the application of VSI and RT-3DE Technology, which has important clinical significance for the early-diagnosition of myocardial function injuration,treatment and prognosis of Kawasaki disease.