Significances of Echocardiography Using Tissue Doppler Imaging for Children in Growth Hormone Therapy

PURPOSE: The purpose of this study is to evaluate the functional changes of the ventricles for 27 children with recombinant human growth hormone (rhGH) therapy in short stature using echocardiography with tissue Doppler imaging. METHODS: The conventional Doppler echocardiography with tissue Doppler imaging were performed in 27 children with rhGH therapy for short stature and 13 healthy children. Peak velocities of systolic (S) and early (E'), late(A') diastolic wave of mitral annulus,septum and tricuspid annulus were obtained from apical 4 chamber view. RESULTS: There was no differences in left ventricle (LV) mass (72.948+/-11.825 m/s2 vs 73.931+/-12.093 m/s2, P=0.08), LV ejection fraction (66.778+/-5.441% vs 70.154+/-6.641%, P=0.095) and LV fractional shortening (36.737+/-4.265% vs 38.085+/-3.419, P=0.327) were observed between patients and controls. There was no significant differences in E and A measured at mitral and tricuspid annulus were observed between pateints and controls. There was no significant differences in S, E' and A' measured using tissue doppler imaging at mitral annulus, septum, and tricuspid annulus were observed between patients and controls CONCLUSION: No significant differences in parameters of cardiac function using tissue doppler imaging with conventional echocardiography were found between patients with rhGH therapy and controls. But, longer follow-up, involving at a larger number of patients, is required to confirm the safety of long-term rhGH treatment.

Plasma Brain Natriuretic Peptide Concentration and Tissue Doppler Imaging for Acute Febrile Phase in Patients with Kawasaki Disease

PURPOSE: The purpose of this study is to evaluate the role of plasma brain natriuretic peptide(BNP) concentraion in Kawasaki disease(KD) and to evaluate the relationship of BNP and Tissue doppler imaging(TDI) in ventricular function. METHODS: Plasma BNP concentration was obtained in the acute phases of KD(n=49) and non-KD(n=36). TDI and conventional echocardiography were performed in 49 patients in acute phase of KD. E' velocity, A' velocity at the lateral mitral annulus, interventricular septum, lateral tricuspid annulus were measured. RESULTS: The mean plasma BNP concentration in patients with KD in the acute phase was significantly higher than non-KD(61.1+/-100.9 pg/mL vs 13.2+/-9.5 pg/mL, P<0.05). There was significant negative correlation with BNP and E' velocity, E/E' ratio at lateral mitral annulus in the aucte phase of KD. CONCLUSION: The level of plasma BNP significantly increased in aucte phase of KD. But, there was no definite level of plasma BNP to diagnosis of KD. Diatolic ventricular function was decreased in acute phase of KD which BNP is elevated by TDI.

Efficacy of Dexamethasone Therapy for Coronary Lesion after Immunoglobulin-retreated Kawasaki Disease

PURPOSE: To evaluate the outcome of coronary lesions for efficacy of dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD). METHODS: Retrospective studies were performed on 438 cases of KD treated with one or two episode of high-dose IVIG and 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD) at this hospital from June 2000 to January 2004. 2D echocardiogram was done at admission, 2 months later and every 2 or 3 months when coronary lesion had improved more than 2 months later. RESULTS: In 108(24.7%) of 438 cases with IVIG therapy only, 10(41.7%) of 24 cases with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), coronary abnormality had been shown by initial 2D-echocardiogram examined at acute stage. In 10(2.3%) of 438 patients with IVIG therapy only, and in 3(12.5%) of 24 cases with additional IVIG retreatment, coronary lesions were still remained at follow-up echocardiogram. Even though it had tendency to increase the coronary lesions in the group with dexamethasone therapy after additional immunoglobulin(IVIG) retreated in initial IVIG-resistant Kawasaki disease(KD), there was no significant differences about the incidence of coronary lesions between two groups. There was no significant differences in age, sex, and other clinical findings between two groups. CONCLUSION: The combination therapy with high doses of IVIG and aspirin in KD is the standard treatment but not always effective. The dexamethasone therapy may be another treatment of choice after additional immunoglobulin(IVIG) retreated in IVIG- resistant Kawasaki disease(KD).