Cardiac Biomarkers for Early Detection of Cardiac Involvement in Children with Kawasaki Disease: A Cross-Sectional Study

Kawasaki disease (KD) is one of the most prevalent vasculitis diseases in children and can bring about serious cardiovascular complications. Early detection of cardiac involvement in KD can play an essential role in managing and preventing the cardiac sequels. We aimed to evaluate the applicability and diagnostic accuracy of cardiac biomarkers including cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic (NT-proBNP) for early detection of cardiac involvement in children with KD. Materials and Methods In this cross sectional study, 32 children with KD who were admitted to the Children's Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, in a three-year period, were consecutively included. Transthoracic echocardiography was performed to evaluate cardiac involvement. Also, the serum levels of NT-proBNP and cTnI were measured to evaluate their diagnostic accuracy. ROC curve analysis was conducted to evaluate the discriminatory power of NT-ProBNP for the diagnosis of cardiac involvement in KD and to determine the best cut-off point at which the sensitivity and specificity were optimal.

Of 32 enrolled patients, 4 (12.5%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and one patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 ng/ml and the NT-proBNP mesurment revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p= 0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent (AUC=1.000, p=0.001).

Unlike the cTnI, our results support the applicability of NT-proBNP as an excellent objective test for early detection of cardiac involvement in children with KD.