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Background: Kawasaki disease(KD) is an immune related multisystemic inflammatory vasculitis in children, especially ensues coronary artery lesions. Several cardiovascular diseases are known to be correlated with sodium level. In this study, we examined the association between serum sodium levels and the severity of coronary artery lesion in acute phase of Kawasaki disease. Objective: The purpose of this study was to determine the association of serum sodium level for predicting cardiac events in Kawasaki disease (KD) patients especially in coronary artery lesions (CALs). Methods: We conducted a retrospective review of the medical records of 158 Kawasaki disease patients from June 2013 to August 2014. We devided the subjects into two groups regarding to the serum sodium level. Various laboratory tests and echocardiographic data were analyzed. Student t-tests were carried out to analyze the significance of the difference in each group. Results: ESR, CRP, BNP, and liver enzymes were significantly greater in lower sodium group. Echocardiographic diastolic marker of mitral E and E/E’ measurement were statistically different. Coronary arterial changes were significant in lower sodium group as well. Conclusions: The lower sodium group demonstrated significant increase of various inflammatory markers and coronary arterial lesions. The sodium level might be associated with the severity of coronary vessel and cardiac inflammation in acute phase of Kawasaki disease.

Abstract: Kawasaki disease(KD) is acute vasculitis in childhood. The authors report the 12-month-old girl with initial presentation of cardiac murmur who was diagnosed incomplete KD. Case: A 12-month-old girl with history of 3 days fever up to 38°C and upper respiratory symptoms including rhinorrhea visited a pediatric clinic. Cardiac murmur was noticed, then she was referred to Pediatric Cardiology clinic. She had loss of appetite and her growth curve showed severely underweight of 8.4kg(less than 3p) compared to height 78cm(50~75p). On hospital day 1, laboratory studies revealed a white blood cell (WBC) 9.4(seg73%, Lym23%)x 103/uL, hemoglobin concentration(Hb) of 5.5 g/dL with hematocrit(Hct) 21%, platelet count 426,000/uL. And laboratory results included ESR 2mm/hr, C-reactive protein 0.05mg/L, AST/ALT 31/19 IU/L, Ferritine 13 ng/mL, TIBC 510ug/dL, Transferrin Saturation Index 2.5% and MCV 50.4fL, MCH 13.4pg, MCHC 26.5g/dL. She had grade II-III/VI end-systolic & early diastolic murmur. The echocardiography showed left main coronary artery dilatation and pericaridial effusion. Based on diagnosis of incomplete Kawasaki disease and iron deficiency anemia, she treated with IVIG(IV gamma globulin), acetylsalicyclic acid, packed RBC transfusion and supplement of oral iron. On hospital day 2, repeat laboratory studies revelaed Hb 6.5 g/dL, and the murmur decreased rapidly. 6 days later Hb was 9.3 g/dL. Pro-BNP was 352 pg/ml on hospital day 1 and repeat studies revealed 978 pg/ml on hospital day 2, 84pg/ml on hospital day 8. The patient was discharged 8 days after admission(on day 11 of her illness) without fever. After 1 month of discharge, she had gained weight to 10.5kg and laboratory study results Hb 11.0 g/dL. And follow-up echorcardiography showed improvement of coronary arteries. The authors report one child presenting with heart murmur under incomplete Kawasaki disease.

To investigate the association of catheter-derived and newer echocardiographically derived measures of diastolic function with rejection in heart transplant recipients, 48 transplant recipients had Doppler and Doppler tissue imaging assessment along with catheter-measured pulmonary capillary wedge pressure (PCWP) at the time of endomyocardial biopsy. Of echocardiographic measures, propagation velocity (Vp), mitral E-wave velocity (E)/Vp, and E/annular mitral E-wave velocity (Em) were significantly associated with rejection (p0.02), and an elevated PCWP was associated with rejection (p = 0.023) but with poor sensitivity. Weak but insignificant correlations with PCWP were found for E/Vp (r = 0.28) and E/Em (r = 0.37).