The Assessment of Diastolic and Systolic Function in Kawasaki Disease Using Myocardial Strain Imaging and Tissue Doppler Imaging: A Systematic Review and Meta‐Analysis

BACKGROUND: Kawasaki disease (KD) is an acute febrile vasculitis that may lead to myocardial dysfunction despite its self-limiting nature. This study aimed to evaluate the impact of KD on systolic and diastolic function using myocardial strain imaging and tissue Doppler imaging (TDI). METHODS: A comprehensive literature review was conducted using electronic databases, including studies assessing systolic and diastolic function markers in KD patients. These markers included global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), early diastolic mitral annular velocity (e'), ratio of mitral valve velocity and mitral annular velocity in early diastole (E/e'), left atrial reservoir strain (LASr), and left atrial volume index (LAVI). Standardized mean differences (SMD) and corresponding 95% confidence intervals (CIs) were pooled in overall and subgroup analyses. Additionally, publication bias, trim and fill analysis, sensitivity analysis including leave-one-out influence analysis, and meta-regression were performed. RESULTS: Thirty-four studies involving 1821 KD patients and 1157 healthy controls (HCs) were included. KD patients showed significantly reduced (less negative) |GLS| (SMD = 0.98, 95% CI: 0.63 to 1.33, p < 0.001) and |GCS|(SMD = 0.37, 95% CI: 0.09 to 0.66, p = 0.010), as well as lower e' (SMD = -0.21, 95% CI: -0.41 to -0.00, p = 0.046) and reduced LASr (SMD = -1.51, 95% CI: -2.56 to -0.47, p = 0.005). Subgroups of age ≤ 5 years continued to show reduced (less negative) |GLS| and |GCS|, lower LASr, and higher E/e' (p < 0.05). Similarly, subgroups with a male proportion ≥50% also demonstrated reduced (less negative) |GLS| and |GCS| and lower LASr (p < 0.05). No significant differences were found in E/e', GRS, and LAVI (all p > 0.05). CONCLUSION: KD is associated with reduced (|GLS| and |GCS|), lower e' velocity, and impaired LASr, while E/e', GRS, and LAVI show no significant overall differences. These findings indicate selective abnormalities detected by myocardial strain imaging and TDI rather than uniform systolic and diastolic impairment, with subgroup results interpreted as exploratory.