{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:04:43Z","timestamp":1781813083749,"version":"3.54.5"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000860","name":"European Society of Cardiology","doi-asserted-by":"publisher","award":["ESC Training Grant"],"award-info":[{"award-number":["ESC Training Grant"]}],"id":[{"id":"10.13039\/501100000860","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7\u2009\u00b1\u20095\u00a0years) were included: 45 children with KD and CADL (KD\/CADL) (Z-score\u2009&gt;\u20092.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD\/CADL patients had lower MWI (1433.2\u2009\u00b1\u2009375.8\u00a0mmHg% vs 1752.2\u2009\u00b1\u2009265.7\u00a0mmHg%, p\u2009&lt;\u20090.001), MCW (1885.5\u2009\u00b1\u2009384.2\u00a0mmHg% vs 2175.9\u2009\u00b1\u2009292.4\u00a0mmHg%, p\u2009=\u20090.001) and MWE (994.0\u2009\u00b1\u20094.8% vs 95.9\u2009\u00b1\u20092.0%, p\u2009=\u20090.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3\u2009\u00b1\u2009361.7\u00a0mmHg%; KD vs CTRL p\u2009=\u20090.028) and was comparable between KD\/CADL and KD groups (KD\/CADL vs KD p\u2009=\u20090.896). Moreover, KD\/CADL patients with normal GLS (n\u2009=\u200938) preserved significant differences in MWI and MCW in comparison with CTRL<jats:bold>.<\/jats:bold> MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.<\/jats:p>","DOI":"10.1038\/s41598-021-86933-5","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T10:09:07Z","timestamp":1618222147000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Abnormal myocardial work in children with Kawasaki disease"],"prefix":"10.1038","volume":"11","author":[{"given":"Jolanda","family":"Sabatino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nunzia","family":"Borrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Fraisse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jethro","family":"Herberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Karagadova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Avesani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Bucciarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjit","family":"Josen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefa","family":"Paredes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Piccinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maraisa","family":"Spada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Krupickova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Indolfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Di Salvo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,12]]},"reference":[{"key":"86933_CR1","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1161\/01.CIR.87.5.1776","volume":"87","author":"AS Dajani","year":"1993","unstructured":"Dajani, A. S. et al. Diagnosis and therapy of Kawasaki disease in children. Circulation 87, 1776\u20131780. https:\/\/doi.org\/10.1161\/01.CIR.87.5.1776 (1993).","journal-title":"Circulation"},{"issue":"17","key":"86933_CR2","doi-asserted-by":"publisher","first-page":"e927","DOI":"10.1161\/CIR.0000000000000484","volume":"135","author":"BW McCrindle","year":"2017","unstructured":"McCrindle, B. W. et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation 135(17), e927\u2013e999. https:\/\/doi.org\/10.1161\/CIR.0000000000000484 (2017).","journal-title":"Circulation"},{"key":"86933_CR3","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1136\/bmj.324.7351.1424","volume":"324","author":"A Harnden","year":"2002","unstructured":"Harnden, A., Alves, B. & Sheikh, A. Rising incidence of Kawasaki disease in England: Analysis of hospital admission data. BMJ 324, 1424\u20131425 (2002).","journal-title":"BMJ"},{"key":"86933_CR4","doi-asserted-by":"publisher","unstructured":"Kato, H. et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 94, 1379\u201385, https:\/\/doi.org\/10.1161\/01.cir.94.6.1379 (1996).","DOI":"10.1161\/01.cir.94.6.1379"},{"issue":"9","key":"86933_CR5","first-page":"470","volume":"105","author":"C Yutani","year":"1981","unstructured":"Yutani, C. et al. Cardiac biopsy of Kawasaki disease. Arch. Pathol. Lab. Med. 105(9), 470\u2013473 (1981).","journal-title":"Arch. Pathol. Lab. Med."},{"issue":"1","key":"86933_CR6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1161\/CIRCIMAGING.112.976969","volume":"6","author":"CE Tacke","year":"2013","unstructured":"Tacke, C. E. et al. Evaluation of cardiac function by magnetic resonance imaging during the follow-up of patients with Kawasaki disease. Circ. Cardiovasc. Imaging. 6(1), 67\u201373. https:\/\/doi.org\/10.1161\/CIRCIMAGING.112.976969 (2013).","journal-title":"Circ. Cardiovasc. Imaging."},{"issue":"5","key":"86933_CR7","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1111\/j.1442-200x.2004.01943.x","volume":"46","author":"A Suzuki","year":"2004","unstructured":"Suzuki, A. et al. Immunohistochemical study of apparently intact coronary artery in a child after Kawasaki disease. Pediatr. Int. 46(5), 590\u2013596 (2004).","journal-title":"Pediatr. Int."},{"key":"86933_CR8","first-page":"217","volume":"139","author":"AM Moran","year":"2000","unstructured":"Moran, A. M. et al. Abnormal myocardial mechanics in Kawasaki disease: Rapid response to gamma-globulin. Am. Heart J. 139, 217\u2013223 (2000).","journal-title":"Am. Heart J."},{"issue":"8","key":"86933_CR9","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1016\/j.echo.2016.03.002","volume":"29","author":"K Liou","year":"2016","unstructured":"Liou, K. et al. Detection of obstructive coronary artery disease using peak systolic global longitudinal strain derived by two-dimensional speckle-tracking: A systematic review and meta-analysis. J. Am. Soc. Echocardiogr. 29(8), 724-735.e4. https:\/\/doi.org\/10.1016\/j.echo.2016.03.002 (2016).","journal-title":"J. Am. Soc. Echocardiogr."},{"issue":"11","key":"86933_CR10","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1093\/ehjci\/jet041","volume":"14","author":"RT McCandless","year":"2013","unstructured":"McCandless, R. T. et al. Myocardial strain and strain rate in Kawasaki disease. Eur. Heart J. Cardiovasc. Imaging. 14(11), 1061\u20131068. https:\/\/doi.org\/10.1093\/ehjci\/jet041 (2013).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"86933_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/chd.12787","volume":"00","author":"AA Sanchez","year":"2019","unstructured":"Sanchez, A. A. et al. Comprehensive left ventricular myocardial deformation assessment in children with Kawasaki disease. Congenit. Heart Dis. 00, 1\u20138. https:\/\/doi.org\/10.1111\/chd.12787 (2019).","journal-title":"Congenit. Heart Dis."},{"issue":"7","key":"86933_CR12","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1016\/j.echo.2004.03.027","volume":"17","author":"GR Sutherland","year":"2004","unstructured":"Sutherland, G. R. et al. Strain and strain rate imaging: A new clinical approach to quantifying regional myocardial function. J. Am. Soc. Echocardiogr. 17(7), 788\u2013802 (2004).","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"86933_CR13","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1093\/ejechocard\/jep041","volume":"10","author":"JO Choi","year":"2009","unstructured":"Choi, J. O. et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur. J. Echocardiogr. 10, 695\u2013701 (2009).","journal-title":"Eur. J. Echocardiogr."},{"issue":"2","key":"86933_CR14","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.echo.2012.10.008","volume":"26","author":"T Yingchoncharoen","year":"2013","unstructured":"Yingchoncharoen, T., Agarwal, S., Popovi\u0107, Z. B. & Marwick, T. H. Normal ranges of left ventricular strain: A meta-analysis. J. Am. Soc. Echocardiogr. 26(2), 185\u2013191. https:\/\/doi.org\/10.1016\/j.echo.2012.10.008 (2013).","journal-title":"J. Am. Soc. Echocardiogr."},{"issue":"12","key":"86933_CR15","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1093\/ehjci\/jey024","volume":"19","author":"A Hubert","year":"2018","unstructured":"Hubert, A. et al. Estimation of myocardial work from pressure-strain loops analysis: An experimental evaluation. Eur. Heart J. Cardiovasc. Imaging. 19(12), 1372\u20131379. https:\/\/doi.org\/10.1093\/ehjci\/jey024 (2018).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"86933_CR16","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1093\/eurheartj\/ehs016","volume":"33","author":"K Russell","year":"2012","unstructured":"Russell, K. et al. A novel clinical method for quantification of regional left ventricular pressure-strain loop area: A non-invasive index of myocardial work. Eur. Heart J. 33, 724\u2013733. https:\/\/doi.org\/10.1093\/eurheartj\/ehs016 (2012).","journal-title":"Eur. Heart J."},{"key":"86933_CR17","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.echo.2017.10.009","volume":"31","author":"E Galli","year":"2018","unstructured":"Galli, E. et al. Value of myocardial work estimation in the prediction of response to cardiac resynchronization therapy. J. Am. Soc. Echocardiogr. 31, 220\u2013230. https:\/\/doi.org\/10.1016\/j.echo.2017.10.009 (2018).","journal-title":"J. Am. Soc. Echocardiogr."},{"issue":"11","key":"86933_CR18","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1093\/ehjci\/jev078","volume":"16","author":"E Boe","year":"2015","unstructured":"Boe, E. et al. Non-invasive myocardial work index identifies acute coronary occlusion in patients with non-ST-segment elevation-acute coronary syndrome. Eur. Heart J. Cardiovasc. Imaging. 16(11), 1247\u20131255. https:\/\/doi.org\/10.1093\/ehjci\/jev078 (2015).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"86933_CR19","doi-asserted-by":"publisher","unstructured":"Kang, S.J. et al. Clinical utility of left atrial strain in children in the acute phase of Kawasaki disease. J. Am. Soc. Echocardiogr. 31(3), 323\u2013332, https:\/\/doi.org\/10.1016\/j.echo.2017.11.012 (2018).","DOI":"10.1016\/j.echo.2017.11.012"},{"issue":"1","key":"86933_CR20","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1006\/mvre.1999.2155","volume":"58","author":"AM Liu","year":"1999","unstructured":"Liu, A. M., Ghazizadeh, M., Onouchi, Z. & Asano, G. Ultrastructural characteristics of myocardial and coronary microvascular lesions in Kawasaki disease. Microvasc. Res. 58(1), 10\u201327 (1999).","journal-title":"Microvasc. Res."},{"key":"86933_CR21","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/0002-9149(77)90192-8","volume":"40","author":"K Sagawa","year":"1977","unstructured":"Sagawa, K., Suga, H., Shoukas, A. A. & Bakalar, K. M. End-systolic pressure\/volume ratio: A new index of ventricular contractility. Am. J. Cardiol. 40, 748\u2013753 (1977).","journal-title":"Am. J. Cardiol."},{"key":"86933_CR22","first-page":"H498","volume":"236","author":"H Suga","year":"1979","unstructured":"Suga, H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Am. J. Physiol. 236, H498-505 (1979).","journal-title":"Am. J. Physiol."},{"key":"86933_CR23","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1161\/01.RES.61.3.318","volume":"61","author":"R Hisano","year":"1987","unstructured":"Hisano, R. & Cooper, G. Correlation of force-length area with oxygen consumption in ferret papillary muscle. Circ. Res. 61, 318\u2013328 (1987).","journal-title":"Circ. Res."},{"key":"86933_CR24","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1113\/jphysiol.1994.sp020209","volume":"477","author":"T Delhaas","year":"1994","unstructured":"Delhaas, T., Arts, T., Prinzen, F. W. & Reneman, R. S. Regional fibre stress-fibre strain area as an estimate of regional blood flow and oxygen demand in the canine heart. J. Physiol. 477, 481\u2013496 (1994).","journal-title":"J. Physiol."},{"issue":"5","key":"86933_CR25","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1093\/ehjci\/jey188","volume":"20","author":"R Manganaro","year":"2018","unstructured":"Manganaro, R. et al. Echocardiographic reference ranges for normal non-invasive myocardial work indices: Results from the EACVI NORRE study. Eur. Heart J. Cardiovasc. Imaging. 20(5), 582\u2013590. https:\/\/doi.org\/10.1093\/ehjci\/jey188 (2018).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"86933_CR26","doi-asserted-by":"publisher","unstructured":"Manganaro, R. et al. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: Results from the EACVI NORRE study. Eur. Heart J. Cardiovasc. Imaging. pii: jez203, https:\/\/doi.org\/10.1093\/ehjci\/jez203 (2019).","DOI":"10.1093\/ehjci\/jez203"},{"issue":"9","key":"86933_CR27","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1093\/ehjci\/jex191","volume":"19","author":"E Galli","year":"2017","unstructured":"Galli, E. et al. Role of myocardial constructive work in the identification of responders to CRT. Eur. Heart J. Cardiovasc. Imaging. 19(9), 1010\u20131018. https:\/\/doi.org\/10.1093\/ehjci\/jex191 (2017).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"issue":"1","key":"86933_CR28","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/ehjci\/jey13","volume":"20","author":"J Chan","year":"2018","unstructured":"Chan, J. et al. A new approach to assess myocardial work by non-invasive left ventricular pressure-strain relations in hypertension and dilated cardiomyopathy. Eur. Heart J. Cardiovasc. Imaging. 20(1), 31\u201339. https:\/\/doi.org\/10.1093\/ehjci\/jey13 (2018).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"issue":"12","key":"86933_CR29","doi-asserted-by":"publisher","first-page":"e0244397","DOI":"10.1371\/journal.pone.0244397","volume":"15","author":"J Sabatino","year":"2020","unstructured":"Sabatino, J. et al. Non-invasive myocardial work is reduced during transient acute coronary occlusion. PLoS ONE 15(12), e0244397. https:\/\/doi.org\/10.1371\/journal.pone.0244397 (2020).","journal-title":"PLoS ONE"},{"issue":"4","key":"86933_CR30","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/S0894-7317(02)74428-3","volume":"16","author":"G Davidavicius","year":"2003","unstructured":"Davidavicius, G. et al. Can regional strain and strain rate measurement be performed during both dobutamine and exercise echocardiography, and do regional deformation responses differ with different forms of stress testing?. J. Am. Soc. Echocardiogr. 16(4), 299\u2013308 (2003).","journal-title":"J. Am. Soc. Echocardiogr."},{"issue":"4","key":"86933_CR31","doi-asserted-by":"publisher","first-page":"e007805","DOI":"10.1161\/CIRCIMAGING.118.007805","volume":"12","author":"J Sabatino","year":"2019","unstructured":"Sabatino, J. et al. Left ventricular twist mechanics to identify left ventricular noncompaction in childhood. Circ. Cardiovasc. Imaging. 12(4), e007805. https:\/\/doi.org\/10.1161\/CIRCIMAGING.118.007805 (2019).","journal-title":"Circ. Cardiovasc. Imaging."},{"key":"86933_CR32","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang, R. M. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging. 16, 233\u2013270. https:\/\/doi.org\/10.1093\/ehjci\/jev014 (2015).","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"86933_CR33","doi-asserted-by":"crossref","unstructured":"Lai, W.W., Cohen, M.S., Geva, T., Mertens, L. Echocardiography in Pediatric and Congenital Heart Disease 765\u2013785. (Wiley-Blackwell, Appendix 1, 2009).","DOI":"10.1002\/9781444306309"},{"key":"86933_CR34","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1016\/j.echo.2019.08.015","volume":"32","author":"KV Bunting","year":"2019","unstructured":"Bunting, K. V. et al. A practical guide to assess reproducibility of echocardiographic measurements. J. Am. Soc. Echocardiogr. 32, 1505\u20131515 (2019).","journal-title":"J. Am. Soc. Echocardiogr."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-86933-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-86933-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-86933-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T06:31:06Z","timestamp":1670049066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-86933-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,12]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["86933"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-86933-5","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,12]]},"assertion":[{"value":"5 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7974"}}