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Liu J, Yuan P, Pang Y, Su D. ITPKC polymorphism (rs7251246 T > C), coronary artery aneurysms, and thrombosis in patients with Kawasaki disease in a Southern Han Chinese population. Front Immunol 2023; 14:1184162. [PMID: 37404818 PMCID: PMC10315485 DOI: 10.3389/fimmu.2023.1184162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives Kawasaki disease (KD) is a commonly acquired pediatric systemic vasculitis disease resulting in coronary artery aneurysm (CAA). The relationship between the ITPKC polymorphism (rs7251246) and the severity and susceptibility to KD in the Han Chinese population in Southern China remains unclear. Methods We enrolled 262 children as controls and 221 children with KD (46 [20.8%] with intravenous immunoglobulin resistance and 82 [37.1%] with CAA). The relationship between the ITPKC rs7251246 polymorphism, KD susceptibility, and CAA formation was investigated. Results While the ITPKC rs7251246 T>C polymorphism was not significantly associated with KD susceptibility, it was significantly related to the CAA risk in children with KD [CC/CT vs. TT: adjusted odds ratio [OR] 2.089, 95% confidence interval [CI] 1.085-4.020]. Male children with the rs7251246 CT/TT genotype had a significantly lower risk of thrombosis [CT/TT vs. CC: adjusted OR 0.251, 95% CI 0.068-0.923]. Children with KD, especially those with CAA, had significantly downregulated ITPKC mRNA compared to healthy children. ITPKC mRNA levels were lower in children with CAA who developed thrombosis (P=0.039). In children with KD, the CC genotype showed lower mRNA levels of ITPKC (P=0.035). Conclusion The ITPKC rs7251246 T>C polymorphism may be a risk factor for CAA and thrombosis in children with KD in the Han Chinese population, likely due to differences in mature mRNA levels caused by interference of RNA splicing. Dual antiplatelet therapy for thrombosis is recommended for male children with the rs7251246 CC genotype.
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Affiliation(s)
| | | | | | - Danyan Su
- *Correspondence: Yusheng Pang, ; Danyan Su,
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Kawada T. Circulating glycocalyx biomarkers in patients with Kawasaki disease: A risk assessment. Microvasc Res 2023; 147:104504. [PMID: 36801271 DOI: 10.1016/j.mvr.2023.104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Japan.
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Robinson C, Schlorff M, Chanchlani R, Gayowsky A, Darling E, Mondal T, Seow H, Batthish M. Cardiovascular Outcomes During Index Hospitalization in Children with Kawasaki Disease in Ontario, Canada. Pediatr Cardiol 2023; 44:681-688. [PMID: 36074151 DOI: 10.1007/s00246-022-02997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
Kawasaki disease (KD) is a common childhood vasculitis associated with coronary artery aneurysms (CAA). However, there is limited published data on other cardiovascular events diagnosed during acute KD hospitalizations. Our objectives were to determine the incidence of cardiovascular events during acute KD hospitalizations, stratified by age at admission, CAA status, and pediatric intensive care unit (PICU) admission status. We identified all children (0-18 year) hospitalized with a new KD diagnosis in Ontario, between 1995 and 2018, through validated algorithms using population health administrative databases. We excluded children previously diagnosed with KD and non-Ontario residents. We evaluated for cardiovascular events that occurred during the acute KD hospitalizations, defined by administrative coding. Among 4597 children hospitalized with KD, 3307 (71.9%) were aged 0-4 years, median length of stay was 3 days (IQR 2-4), 113 children (2.5%) had PICU admissions, and 119 (2.6%) were diagnosed with CAA. During acute hospitalization, 75 children were diagnosed with myocarditis or pericarditis (1.6%), 47 with arrhythmias (1.0%), 25 with heart failure (0.5%), and ≤ 5 with acute MI (≤ 0.1%). Seven children underwent cardiovascular procedures (0.2%). Older children (10-18 years), children with CAA, and children admitted to the PICU were more likely to experience cardiovascular events, compared with children aged 0-4 years, without CAA or non-PICU admissions, respectively. The frequency of non-CAA cardiovascular events during acute KD hospitalizations did not change significantly between 1995 and 2018. During acute KD hospitalizations, older children, children with CAA, and PICU admissions are at higher risk of cardiovascular complications, justifying closer monitoring of these high-risk individuals.
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Affiliation(s)
- Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Megan Schlorff
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Elizabeth Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Tapas Mondal
- Division of Cardiology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Liu J, Su D, Yuan P, Huang Y, Ye B, Liang K, Pang Y. Prognostic nutritional index value in the prognosis of Kawasaki disease with coronary artery lesions. Front Nutr 2023; 10:1075619. [PMID: 36819679 PMCID: PMC9929364 DOI: 10.3389/fnut.2023.1075619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives The prognostic nutritional index (PNI) is a purported predictor of intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) development in patients with Kawasaki disease (KD). However, limited data exist on CAA regression. This study aimed to confirm whether the PNI is a predictor for CAA persistency in patients with KD. Methods This retrospective study grouped 341 patients with KD based on the coronary artery status and time of aneurysm persistence. The clinical and laboratory parameters were compared, and multivariate logistic regression analysis was performed to identify the independent risk factors for persistent CAA. The receiver operating characteristic (ROC) curve was further used to assess the predictive values of the PNI in persistent CAA. Results Among the study patients, 80 (23.5%) presented with CAA, including CAA persisting for 2 years in 17 patients (5.0%). Patients with CAA were more frequently treated with corticosteroids (p < 0.016). No statistically significant differences were found in the nutritional status and PNI among patients with or without coronary artery lesions, regardless of injury severity. Patients in the persistent CAA group presented with higher rates of overnutrition and showed lower PNI values and a higher incidence of thrombosis than those in the normal group (p < 0.05). The PNI and the maximum Z-score at 1 month of onset were significantly associated with CAA persisting for 2 years and may be used as predictors of persistent CAA. The area under the ROC curve was 0.708 (95% confidence interval, 0.569-0.847), and a 40.2 PNI cutoff yielded a sensitivity and specificity of 41 and 92%, respectively, for predicting CAA persisting for 2 years. Kaplan-Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in patients with PNI values of ≤40 than in those with PNI values of >40 (hazard ratio, 2.958; 95% confidence interval, 1.601-5.464; p = 0.007). After sampling-time stratification, the PNI differed significantly between patients with and without persistent CAA when sampled on the second (p = 0.040), third (p = 0.028), and fourth days (p = 0.041) following disease onset. Conclusion A lower PNI value is an independent risk factor for CAA persisting for 2 years in patients with KD, besides the maximum Z-score at 1 month after onset. Furthermore, the PNI obtained within 4 days from fever onset may possess greater predictive power for patients with persistent CAA.
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Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study. Pediatr Res 2022; 93:1267-1275. [PMID: 36380069 DOI: 10.1038/s41390-022-02391-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of cardiovascular events after Kawasaki disease (KD) remains uncertain. Our objective was to determine the risk of cardiovascular events and mortality after KD. METHODS Population-based retrospective cohort study using Ontario health administrative databases (0-18 years; 1995-2018). EXPOSURE pediatric KD hospitalizations. Each case was matched to 100 non-exposed controls. PRIMARY OUTCOME major adverse cardiac events (MACE; cardiovascular death, myocardial infarction, or stroke composite). SECONDARY OUTCOMES composite cardiovascular events and mortality. We determined incidence rates and adjusted hazard ratios (aHR) using multivariable Cox models. RESULTS Among 4597 KD survivors, 79 (1.7%) experienced MACE, 632 (13.8%) composite cardiovascular events, and 9 (0.2%) died during 11-year median follow-up. The most frequent cardiovascular events among KD survivors were ischemic heart disease (4.6 events/1000 person-years) and arrhythmias (4.5/1000 person-years). KD survivors were at increased risk of MACE between 0-1 and 5-10 years, and composite cardiovascular events at all time periods post-discharge. KD survivors had a lower mortality risk throughout follow-up (aHR 0.36, 95% CI 0.19-0.70). CONCLUSION KD survivors are at increased risk of post-discharge cardiovascular events but have a lower risk of death, which justifies enhanced cardiovascular disease surveillance in these patients. IMPACT Among 4597 Kawasaki disease (KD) survivors, 79 (1.7%) experienced major adverse cardiac events (MACE) and 632 (13.8%) had composite cardiovascular events during 11-year median follow-up. KD survivors had significantly higher risks of post-discharge MACE and cardiovascular events versus non-exposed children. Only nine KD survivors (0.2%) died during follow-up, and the risk of mortality was significantly lower among KD survivors versus non-exposed children. Childhood KD survivors should receive preventative counseling and cardiovascular surveillance, aiming to mitigate adult cardiovascular disease.
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Liu J, Yue Q, Qin S, Su D, Ye B, Pang Y. Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease. Front Cardiovasc Med 2022; 9:969495. [PMID: 36158849 PMCID: PMC9505689 DOI: 10.3389/fcvm.2022.969495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
Coronary artery aneurysm (CAA) is a serious cardiac complication arising from Kawasaki disease (KD) and is becoming the leading cause of acquired heart disease in children. The aim of this study was to determine the potential risk factors associated with coronary artery aneurysms (CAAs), which differ in size and emergence time, and track its regression within 3 years of onset. The laboratory data, clinical features, and coronary artery outcomes of patients, who were diagnosed with KD and received treatment from January 2003 to January 2019 were retrospectively analyzed. A total of 484 pediatric patients with KD were examined during the study period. Among them, 130 (26.9%) presented with CAA, including mid- to large-sized CAA in 38 patients (7.9%) and de novo CAA after intravenous immunoglobulin (IVIG) treatment in 22 patients (4.5%). Albumin-to-globin (A/G) ratio was significantly negatively associated with the absolute internal diameter of coronary artery at 1 month of onset and may be used as a predictor of mid- to large-sized CAA development in patients with KD. The area under the receiver operating characteristic curve was 0.637 (95% confidence interval: 0.551–0.724), and a cutoff of 1.32 yielded a sensitivity and specificity of 79 and 49%, respectively, for predicting mid- to large-sized CAA development. De novo CAA after IVIG may lead to an increased risk of developing progressive CAA [13 (59.1%) of 22 vs. 31 (28.7%) of 108; P = 0.006] and had significantly greater changes in both the magnitude of CAA dimension variation and maximum z-score of the coronary arteries at 2 and 4 weeks and then 3 months after onset (P < 0.001). Kaplan–Meier survival analysis revealed that the estimated median time of aneurysm persistence was significantly higher in the progressive CAA group than in the non-progressive CAA group (25 vs. 4 months, P < 0.001), as well as among the three groups of patients (giant CAA > medium-sized CAA > small-sized CAA, P < 0.001). Children with KD who had low A/G ratio were more likely to develop mid- to large-sized CAA. Nevertheless, de novo CAA after IVIG treatment may increase the risk of more severe arterial damage and development of progressive coronary artery damage; and both mid- to large-sized and de novo CAA could dramatically prolong coronary artery normalization time. Thus, aggressive risk modifications should be employed, and close monitoring with frequent echocardiography is needed for this vulnerable patient population.
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Lee JJY, Feldman BM, McCrindle BW, Li P, Yeung RS, Widdifield J. Evaluating the time-varying risk of hypertension, cardiac events, and mortality following Kawasaki disease diagnosis. Pediatr Res 2022; 93:1439-1446. [PMID: 36002584 DOI: 10.1038/s41390-022-02273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study evaluated the risk of hypertension, major adverse cardiac events (MACE), and all-cause mortality in Kawasaki disease (KD) patients up to young adulthood. METHODS An inception cohort of 1169 KD patients between 1991 and 2008 from a tertiary-level hospital in Ontario, Canada was linked with health administrative data to ascertain outcomes up to 28 years of follow-up. Their risk was compared with 11,690 matched population comparators. The primary outcome was hypertension and secondary outcomes were MACE and death. RESULTS After a median follow-up of 20 years [IQR: 8.3], the cumulative incidence of hypertension and MACE in the KD group was 3.8% (95% CI: 2.5-5.5) and 1.2% (95% CI: 0.6-2.4%), respectively. The overall survival probability in the KD group was 98.6% (95% CI: 97.2-99.3%). Relative to comparators, KD patients were at an increased risk for hypertension [aHR: 2.2 (95% CI: 1.5-3.4)], death [aHR: 2.5 (95% CI: 1.3-5.0)], and MACE [aHR: 10.7 (95% CI: 6.4-17.9)]. For hypertension and MACE, the aHR was the highest following diagnosis and then the excess risk diminished after 16 and 13 years of follow-up, respectively. MACE occurred largely in KD patients with coronary aneurysms [cumulative incidence: 12.8%]. CONCLUSIONS KD patients demonstrated a reassuring cardiac prognosis up to young adulthood with low events and excellent survival. KD patients were at increased risk for hypertension, but this excess risk occurred early and declined with time. IMPACT With the current standard of care, KD patients demonstrated favorable cardiac prognosis, with low events of hypertension, MACE, and excellent survival. Hypertension and MACE risk appear to be highest around the time of KD diagnosis. MACE occurred primarily in KD patients with coronary aneurysms. Our findings are reassuring to KD patients, families, and their providers. Our study demonstrated an association between KD exposure and hypertension. This association is relatively novel. Previous studies have remained conflicting if KD contributes to long-term atherosclerotic risk.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian W McCrindle
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Rae Sm Yeung
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jessica Widdifield
- ICES, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
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Lee JJY, Lin E, Widdifield J, Mahood Q, McCrindle BW, Yeung RSM, Feldman BM. The Long-term Cardiac and Noncardiac Prognosis of Kawasaki Disease: A Systematic Review. Pediatrics 2022; 149:184739. [PMID: 35118494 DOI: 10.1542/peds.2021-052567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
CONTEXT It is uncertain if children with Kawasaki Disease (KD) are at risk for non-cardiac diseases and if children with KD but without coronary artery aneurysms (CAA) are at risk for long-term cardiac complications. OBJECTIVE To determine the long-term mortality and prognosis of children after KD. DATA SOURCES Medline, Embase, and the Cochrane Central Register. STUDY SELECTION Controlled trials and observational studies were included if they included children with KD and reported mortality, major adverse cardiovascular events (MACE), chronic cardiac or other disease over an average follow-up of ≥1 year. DATA EXTRACTION Data extracted included sample size, age at diagnosis, the proportion with coronary artery aneurysms (CAA), follow-up duration, and outcome(s). RESULTS Seventy-four studies were included. Thirty-six studies reported mortality, 55 reported a cardiac outcome, and 12 reported a noncardiac outcome. Survival ranged from 92% to 99% at 10 years, 85% to 99% at 20 years, and 88% to 94% at 30 years. MACE-free survival, mostly studied in those with CAA, varied from 66% to 91% at 10 years, 29% to 74% at 20 years, and 36% to 96% at 30 years. Seven of 10 studies reported an increased risk in early atherosclerosis. All 6 included studies demonstrated an increased risk in allergic diseases. LIMITATIONS Our study may have missed associated chronic comorbidities because short-term studies were excluded. The majority of outcomes were evaluated in East-Asian patients, which may limit generalizability. Studies frequently excluded patients without CAA and did not compare outcomes to a comparison group. CONCLUSIONS Studies demonstrate >90% survival up to 30 years follow-up. MACE is observed in children with CAA, but is not well studied in those without CAA.
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Affiliation(s)
- Jennifer J Y Lee
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Ethan Lin
- University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Widdifield
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Quenby Mahood
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Brian W McCrindle
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Rae S M Yeung
- Department of Pediatrics.,Institute of Medical Science.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Brian M Feldman
- Department of Pediatrics.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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Naimi I, Slee AE, Kourtidou S, Mangione-Smith RM, Portman MA. Long-Term Impact of Hospitalization for Kawasaki Disease on Health-Related Quality of Life. Hosp Pediatr 2022; 12:248-257. [PMID: 35102391 DOI: 10.1542/hpeds.2021-006308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To prospectively evaluate the long-term impact of Kawasaki disease (KD) hospitalization on health-related quality of life (HRQoL). METHODS We merged the Outcomes Assessment Program and KD databases and queried for KD admissions between 1 month and 18 years of age. Patients with a diagnosis of community-acquired pneumonia were included as a comparison group. HRQoL was evaluated with the parent proxy Pediatric Quality of Life Inventory (PedsQL). Long-term follow-up PedsQL surveys were performed at least 1 year after initial diagnosis and hospitalization. Results for the entire cohort adjusted for significant differences were calculated. Propensity score-matched cohorts were constructed from the unmatched cohorts of patients with long-term survey responses. Subgroup analysis for the KD group was performed. RESULTS Patients with KD (n = 61) versus pneumonia (n = 80) had a lower PedsQL total score on admission and experienced a significantly greater HRQoL decline from baseline to admission. At long-term follow-up, no difference occurred in HRQoL between patients with KD and pneumonia, and 89% of patients with KD reached their baseline PedsQL scores. KD diagnostic subtype, coronary artery dilatation, and need for longer follow-up were not associated with HRQoL outcomes at any time point. Intravenous immunoglobulin nonresponders demonstrated lower HRQoL at admission, which did not persist at follow-up. CONCLUSIONS Children with KD experience acute and significant HRQoL impairment exceeding that of children with newly diagnosed pneumonia, but the scores return to baseline at long-term follow-up. The recoveries at short- and long-term intervals are similar to patients with pneumonia.
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Affiliation(s)
- Iman Naimi
- Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - April E Slee
- Medical Statistics, New Arch Consulting, Seattle, Washington
| | - Soultana Kourtidou
- Division of Pediatric Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Rita M Mangione-Smith
- Kaiser Permanente Washington Health Research Institute, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Seattle, Washington
| | - Michal A Portman
- Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
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Robinson C, Chanchlani R, Gayowsky A, Darling E, Seow H, Batthish M. Health care utilization and costs following Kawasaki disease. Paediatr Child Health 2022; 27:160-168. [PMID: 35712030 PMCID: PMC9191915 DOI: 10.1093/pch/pxab092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Kawasaki disease (KD) is a common childhood vasculitis with increasing incidence in Canada. Acute KD hospitalizations are associated with high health care costs. However, there is minimal health care utilization data following initial hospitalization. Our objective was to determine rates of health care utilization and costs following KD diagnosis. Methods We used population-based health administrative databases to identify all children (0 to 18 years) hospitalized for KD in Ontario between 1995 and 2018. Each case was matched to 100 nonexposed comparators by age, sex, and index year. Follow-up continued until death or March 2019. Our primary outcomes were rates of hospitalization, emergency department (ED), and outpatient physician visits. Our secondary outcomes were sector-specific and total health care costs. Results We compared 4,597 KD cases to 459,700 matched comparators. KD cases had higher rates of hospitalization (adjusted rate ratio 2.07, 95%CI 2.00 to 2.15), outpatient visits (1.30, 95%CI 1.28 to 1.33), and ED visits (1.22, 95%CI 1.18 to 1.26) throughout follow-up. Within 1 year post-discharge, 717 (15.6%) KD cases were re-hospitalized, 4,587 (99.8%) had ≥1 outpatient physician visit and 1,695 (45.5%) had ≥1 ED visit. KD cases had higher composite health care costs post-discharge (e.g., median cost within 1 year: $2466 CAD [KD cases] versus $234 [comparators]). Total health care costs for KD cases, respectively, were $13.9 million within 1 year post-discharge and $54.8 million throughout follow-up (versus $2.2 million and $23.9 million for an equivalent number of comparators). Conclusions Following diagnosis, KD cases had higher rates of health care utilization and costs versus nonexposed children. The rising incidence and costs associated with KD could place a significant burden on health care systems.
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Affiliation(s)
- Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada,Division of Nephrology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rahul Chanchlani
- Division of Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada,ICES McMaster, Hamilton, Ontario, Canada
| | | | - Elizabeth Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Batthish
- Correspondence: Michelle Batthish, Division of Rheumatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. Telephone 905-521-2100, fax 905-521-4968, e-mail
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Li Y, Xu Z, Wu L, Liang X, Zhao L, Liu F, Wang F. Tenascin-C predicts IVIG non-responsiveness and coronary artery lesions in kawasaki disease in a Chinese cohort. Front Pediatr 2022; 10:979026. [PMID: 36582508 PMCID: PMC9792982 DOI: 10.3389/fped.2022.979026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the predictive value of tenascin-C (TN-C) for intravenous immunoglobulin (IVIG) non-responsiveness and coronary artery lesions (CALs) development at the acute stage of Kawasaki disease, and to build novel scoring systems for identifying IVIG non-responsiveness and CALs. METHODS A total of 261 patients in acute-stage Kawasaki disease were included. Serum samples before IVIG initiation were collected and TN-C expression levels were measured using an enzyme-linked immunosorbent assay. In addition to TN-C, another fifteen clinical and laboratory parameters collected before treatment were compared between IVIG responsive and non-responsive groups, and between groups with and without CALs. Multiple logistic regression analyses were performed to construct new scoring systems for the prediction of IVIG non-responsiveness and CALs development. RESULTS IVIG non-responsive group (n = 51) had significantly higher TN-C level compared to IVIG responsive group (n = 210) (15.44 vs. 12.38 IU/L, P < 0.001). A novel scoring system composed of TN-C, total bilirubin, serum sodium and albumin was established to predict IVIG non-responsiveness. Patients with a total score ≥ 2 points were classified as high-risk cases. With the sensitivity of 78.4% and specificity of 73.8%, the efficiency of our scoring system for predicting IVIG non-responsiveness was comparable to the Kobayashi system. Consistently, the group developing CALs at the acute stage (n = 42) had significantly higher TN-C level compared to the group without CALs (n = 219) (19.76 vs. 12.10 IU/L, P < 0.001). A new scoring system showed that patients with elevated TN-C, platelet count ≥ 450 × 109/L, and delayed initial infusion of IVIG had a higher risk of developing CALs. Individuals with a total score ≥ 3 points were classified as high-risk cases. The sensitivity and specificity of the novel simple system for predicting CALs development were 83.3% and 74.0%, respectively, yielding a better efficiency than the Harada score. CONCLUSION Elevated TN-C appeared to be an independent risk factor for both IVIG non-responsiveness and CALs in Chinese children with KD. Our scoring systems containing TN-C is simple and efficient in the early identification of high-risk KD cases that could benefit from more individualized medications.
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Affiliation(s)
- Yujie Li
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Ziqing Xu
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Wu
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Xuecun Liang
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Lu Zhao
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Liu
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
| | - Feng Wang
- Department of Cardiology, Children's Hospital of Fudan University, Shanghai, China
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Lin KL, Liou IH, Chen GB, Sun SF, Weng KP, Li CH, Tuan SH. Serial Exercise Testing and Echocardiography Findings of Patients With Kawasaki Disease. Front Pediatr 2022; 10:847343. [PMID: 35402363 PMCID: PMC8983877 DOI: 10.3389/fped.2022.847343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is the most common form of pediatric vasculitis. We evaluated the influence of KD on cardiopulmonary function and analyzed the echocardiographic findings of patients with KD through serial follow-ups from childhood to adolescence. METHODS This was a retrospective study. We recruited patients with KD after the acute stage who underwent at least two (with >1-year interval between visits) cardiopulmonary exercise testing (CPET) and echocardiographic examinations in the last 10 years. Cardiopulmonary function was determined through CPET on a treadmill. The maximum Z score (Max-Z) of the proximal left anterior descending coronary artery or right coronary artery was determined using echocardiography. Healthy peers matched for age, sex, and body mass index with serial CPET and echocardiographic data were recruited as a control group. RESULTS Each group consisted of 30 participants with comparable basic characteristics. No significant differences in the variables of the first CPET were observed between the two groups. In the final CPET, the control group had a higher percentage of measured oxygen consumption (Vo2) at the anaerobic threshold (AT) to the predicted peak Vo2 (p = 0.016), higher percentage of measured peak Vo2 to the predicted peak Vo2 (p = 0.0004), and higher Vo2 at AT (p < 0.0001) than those of the KD group. No significant difference in the percentage of distribution of Max-Z was observed between the first and final echocardiographic examinations. CONCLUSIONS Children with a history of KD had comparable exercise capacity to their healthy peers. However, in the follow-up, the aerobic metabolism and peak exercise load capacities of adolescents with KD were significantly lower than those of control adolescents.
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Affiliation(s)
- Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
| | - Shu-Fen Sun
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ken-Pen Weng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Chien-Hui Li
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan
| | - Sheng-Hui Tuan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.,Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan
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Maity M, Mukhopadhyay D, Sabui T, Mondal R, De J. A comparative study to assess vascular health in previously diagnosed patients of kawasaki disease. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_263_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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A new scoring system for coronary artery abnormalities in Kawasaki disease. Pediatr Res 2022; 92:275-283. [PMID: 34584222 PMCID: PMC8476714 DOI: 10.1038/s41390-021-01752-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/09/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In China, coronary artery abnormalities (CAAs) secondary to Kawasaki disease (KD) tend to have an increased occurrence. We hypothesize that Chinese children with KD may possess several unique CAA risks, and the predictive efficacy of multiple scoring systems in Chinese patients are still to be further studied. METHODS Two hundred and three KD patients were recruited. Using multivariable analysis, independent predictors of CAAs were combined into a scoring system. Subsequently, CAA risks of our patients were evaluated by the newly established scoring system and eight other published scoring systems. RESULTS Seventeen (8.37%) KD patients were identified as CAAs. The newly established scoring system contained the following 5 independent predictors: days of illness at initial treatment ≥7, redness and swelling of extremities, hematocrit ≤33%, percentage of monocytes ≥8.89%, and procalcitonin ≥0.5 ng/mL. The AUC value of newly established scoring system was 0.685 with a sensitivity of 41.18% and a specificity of 84.41%, higher than Harada score, Egami score, Kobayashi score, Sato score, San Diego score, Formosa score, and Tang score, whereas lower than Hua score. CONCLUSIONS Days of illness at initial treatment ≥7 and procalcitonin are unique predictors of CAAs in newly established scoring system. Taking into account different identification criteria and analytical methodologies, there is still some heterogeneity among different scoring systems. IMPACT The newly established scoring system contains the five independent predictors. Days of illness at initial treatment ≥7 and PCT are unique predictors of CAAs in our study, compared with 8 other systems. The AUC value of newly established scoring system is 0.685, similar to Hua score. There is some heterogeneity among different scoring systems.
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15
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Robinson C, Chanchlani R, Gayowsky A, Brar S, Darling E, Demers C, Klowak J, Knight B, Kuenzig E, Mondal T, Parekh R, Seow H, Jimenez-Rivera C, Webster R, Fung S, Benchimol EI, Batthish M. Incidence and short-term outcomes of Kawasaki disease. Pediatr Res 2021; 90:670-677. [PMID: 33785879 DOI: 10.1038/s41390-021-01496-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Kawasaki disease (KD) is a childhood vasculitis with conflicting reported North American trends in incidence and patient characteristics. OBJECTIVES (1) determine KD incidence between 1995 and 2017; (2) compare patient characteristics by era and age group; (3) determine complication and cardiovascular follow-up rates. METHODS We used population-based health administrative data to identify children (0-18 yr) hospitalized with KD in Ontario, Canada between 1995 and 2017. We excluded children with prior KD diagnosis or incomplete records. We determined the annualized incidence and follow-up trends. RESULTS KD was diagnosed in 4,346 children between 1995 and 2017. Annual KD incidence was 22.0 (<5 yr), 6.1 (5-9 yr), and 0.6 (10-18 yr) per 100,000 children. KD incidence increased significantly for all age groups, including from 18.4 to 25.0 cases per 100,000 children <5 yr. Ninety-day mortality occurred in ≤5 children (≤0.1%). Coronary artery aneurysm (CAA) occurred in 106 children (2.4%, 95% confidence interval 2.0-2.9) during admission and 151 (3.5%, 95% confidence interval 3.0-4.1) during 11-year median follow-up. Children 10-18 yr had longer hospitalizations (4.3 vs. 3.5 days, p = 0.003) and more CAA (7.4% vs. 3.4%, p = 0.007). By 1-year post-diagnosis, 3970 (91.3%) and 2576 (59.3%) children had echocardiography and cardiology follow-up, respectively. CONCLUSIONS KD incidence is increasing in Ontario, with greater healthcare utilization from hospitalizations and subsequent follow-up. IMPACT 4346 children were hospitalized for Kawasaki disease over 22 years in Ontario, and Kawasaki disease incidence increased significantly for all age groups, males and females. Older children (10-18 years) had longer hospital length of stay, more PICU admissions and more frequent coronary artery aneurysms. Nearly all children with Kawasaki disease had follow-up echocardiography within 1 year.
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Affiliation(s)
- Cal Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,ICES McMaster, Hamilton, ON, Canada
| | | | - Sandeep Brar
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Elizabeth Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Catherine Demers
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | - Jennifer Klowak
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Braden Knight
- ICES Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ellen Kuenzig
- ICES Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Tapas Mondal
- Division of Pediatric Cardiology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Rulan Parekh
- Division of Pediatric Nephrology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Carolina Jimenez-Rivera
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Richard Webster
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Stephen Fung
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Eric I Benchimol
- ICES Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Batthish
- Division of Pediatric Rheumatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
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Wang Z, Zhang J, Dong L. Is there any association between asthma and Kawasaki disease? A systematic review and meta-analysis. Pediatr Pulmonol 2021; 56:2503-2511. [PMID: 33983684 DOI: 10.1002/ppul.25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Shared immune factors are involved in the pathogenesis of asthma and Kawasaki disease (KD). Consequently, several observational studies have explored an association between KD and asthma. This systematic review and meta-analysis aimed to explore the association between KD and asthma. METHODS PubMed and Embase databases were searched for cross-sectional, case-control and cohort studies that investigated the association between KD and asthma. The first author, publication year, study type, sample size, and participant demographics were retrieved. The association between KD and asthma was expressed by the odds ratio (OR) and 95% confidence interval (CI). RESULTS Eleven studies were eligible in the systematic review. The crude ORs (cORs) were extracted from 11 studies, and seven of them also provided adjusted ORs (aORs). The cORs between KD and asthma was 1.53 (95% CI, 1.29-1.81). After adjustment for some confounding factors (age, sex, region), asthma also had an association with KD (aOR, 1.08; 95% CI, 1.00-1.17). The subgroup analyses showed the study design and study location to influence between-study heterogeneity. Analyses of aOR values revealed that asthma onset before KD onset does not appear to increase KD prevalence, whereas people suffering from KD could increase the prevalence of developing asthma. CONCLUSION Our meta-analysis suggested a possible association between preceding KD and asthma onset, but care must be taken when interpreting this result. Prospective cohort studies are needed to assess a causal relationship between these two diseases.
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Affiliation(s)
- Zihan Wang
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
| | - Jintao Zhang
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
| | - Liang Dong
- Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
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17
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Peter E, Fraison JB, Harbaoui B, Paut IK, Dauphin C, Gomard-Mennesson E, Hervier B, De Boysson H, Varron L, Keraen J, Pugnet G, Gobert D, Bachmeyer C, Humbert S, Landron C, Roblot P, Cathébras P, Gerfaud-Valentin M, Weber E, Jamilloux Y, Fain O, Seve P. Cardiovascular outcome in adult-onset Kawasaki disease. Autoimmun Rev 2021; 20:102886. [PMID: 34237418 DOI: 10.1016/j.autrev.2021.102886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Elise Peter
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France
| | | | - Brahim Harbaoui
- Service Cardiologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France
| | - Isabelle Kone Paut
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, Université Paris Sud, assistance publique des hôpitaux de Paris, France
| | - Claire Dauphin
- Service de Cardiologie, Hôpital Gabriel Montpied, Université de Clermont, France
| | | | - Baptiste Hervier
- Service de Médecine Interne, Institut E3M, Hôpital de la Pitié-Salpêtrière and Sorbonnes Universités, UPMC Université Paris 6, France
| | - Hubert De Boysson
- Service de Médecine Interne, Centre Hospitalier Universitaire de Caen, Université de Caen, France
| | - Loig Varron
- Service de Médecine Interne, Centre Hospitalier de Montélimar, France
| | - Jérémy Keraen
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Grégory Pugnet
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, France
| | - Delphine Gobert
- Service de Médecine Interne, Hôpital Saint Antoine, assistance publique des hôpitaux de Paris, Université Paris 6, France
| | - Claude Bachmeyer
- Service de Médecine Interne, Centre Hospitalier de Creil, France
| | - Sébastien Humbert
- Service de Médecine Interne, Centre Hospitalier Universitaire de Besançon, France
| | - Cédric Landron
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Pascal Roblot
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, France
| | - Pascal Cathébras
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Université de Saint-Etienne, France
| | - Mathieu Gerfaud-Valentin
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France
| | - Emmanuelle Weber
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France
| | - Yvan Jamilloux
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint Antoine, assistance publique des hôpitaux de Paris, Université Paris 6, France
| | - Pascal Seve
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Université de Lyon, France.
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18
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Tsuchihashi T, Kakimoto N, Takeuchi T, Suenaga T, Suzuki T, Shibuta S, Ino Y, Kubo T, Akasaka T, Suzuki H. Intimal thickening and disruption of the media occur in the arterial walls of coronary arteries not associated with coronary arterial aneurysms in patients with Kawasaki disease. BMC Cardiovasc Disord 2021; 21:278. [PMID: 34090349 PMCID: PMC8180057 DOI: 10.1186/s12872-021-02090-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022] Open
Abstract
Background Coronary artery aneurysm (CAA) is an important complication of Kawasaki disease (KD) that is associated with arterial structure damage. However, few studies have examined structural changes in coronary arteries that are not associated with CAA. Methods We examined coronary arteries in KD patients with CAAs who underwent follow-up coronary angiography (CAG) and optical coherence tomography (OCT). Coronary arterial branches with no abnormal findings during the most recent CAG were classified into two groups. Arteries with an acute-phase CAA that later regressed were classified as group R; arteries with no abnormal findings on either acute or convalescent phase CAG were classified as group N. Coronary arterial wall structural changes were compared between groups using OCT. Results Fifty-seven coronary arterial branches in 23 patients were evaluated by OCT. Thirty-six branches showed no abnormality during the most recent CAG. Both groups R and N comprised 18 branches. Maximum intimal thicknesses in groups R and N were 475 and 355 µm, respectively (p = 0.007). The incidences of media disruption were 100% and 67%, respectively (p = 0.02). Calcification, macrophage accumulation, and thrombus were not found in either group. Conclusions Intimal thickening and disruption of the media occur in coronary arteries with acute phase CAAs that later regress in the convalescent phase, as well as in arteries with normal CAG findings in the acute and convalescent phases.
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Affiliation(s)
- Tomoya Tsuchihashi
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Takashi Takeuchi
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Shoichi Shibuta
- Department of Pediatrics, Kinan Hospital, 46-70 Shinjo-cho, Tanabe, Wakayama, 646-8588, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
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Liu HH, Qiu Z, Fan GZ, Jiang Q, Li RX, Chen WX, Liu FF, Wu Y, Wang JJ, Wu YF, Luo HH, Zhang DD, Hu P. Assessment of coronary artery abnormalities and variability of Z-score calculation in the acute episode of Kawasaki disease-A retrospective study from China. Eur J Clin Invest 2021; 51:e13409. [PMID: 32916764 DOI: 10.1111/eci.13409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate classification of coronary artery abnormalities (CAAs) is essential for clinical decision-making and long-term management in Kawasaki disease (KD) patients. To date, there are several echocardiographic criteria of CAA assessment. MATERIALS AND METHODS The Japanese Ministry of Health (JMH) criteria and the Z-score criteria from 2004 American Heart Association guidelines were adopted and their detective efficacies for CAAs were compared in 251 Chinese patients with KD Z scores were calculated by 6 published methods. RESULTS According to the JMH criteria, 19 (7.57%) KD patients were classified as CAAs during the acute KD episode. However, the detective number of CAAs was highest and had a 0.68-fold increase by the Dallaire et al method with a Z-score cut point of ≥2.5 as compared with the JMH criteria; in contrast, more than 78.95% of patients with CAAs identified by the JMH criteria had a coronary artery Z score ≥2.5. All 6 different Z-score methods had satisfactory accuracies with a range from 93.23% to 97.61% in screening CAAs. For the 19 patients with CAAs identified by the JMH criteria, their Z scores presented the widest variation calculated by the McCrindle et al method. CONCLUSIONS The JMH criteria underestimate the prevalence of CAAs as compared with the Z-score criteria. Quantitative assessment of coronary artery luminal dimensions, normalized as Z scores adjusted for body surface, should be recommended. The larger coronary artery luminal dimensions vary, the more heterogeneous Z scores calculated by different methods have.
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Affiliation(s)
- Hui Hui Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Zhen Qiu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Guo Zhen Fan
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Qi Jiang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Rui Xue Li
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Wei Xia Chen
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Fei Fei Liu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yue Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Jing Jing Wang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Yang Fang Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Huang Huang Luo
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Dong Dong Zhang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, PR China
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20
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Refractory Kawasaki Disease—a Challenge for the Pediatrician. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:855-860. [PMID: 33532696 PMCID: PMC7843002 DOI: 10.1007/s42399-021-00775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 10/27/2022]
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21
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Faim D, Henriques C, Brett A, Francisco A, Rodrigues F, Pires A. Kawasaki Disease: Predictors of Resistance to Intravenous Immunoglobulin and Cardiac Complications. Arq Bras Cardiol 2021; 116:485-491. [PMID: 33470332 PMCID: PMC8159558 DOI: 10.36660/abc.20190758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the leading cause of acquired cardiac disease in children, in developed countries. OBJECTIVES To identify predictive factors for resistance to intravenous immunoglobulin (IVIG), calculate the effectiveness of Japanese predictive models and characterize cardiac complications. METHODS Retrospective analysis of KD cases admitted in a Portuguese paediatric hospital between january 2006 and july 2018. ROC curves were used to determine predictive factors for resistance and the multivariate logistic regression analysis was used to develop the predictive model. A significance level of 5% was used. RESULTS 48 patients with a median age of 36 months were included. The IVIG resistance was 21%. Echocardiographic anomalies were noted in 46%, with coronary involvement in 25% of the sample population. As predictive variable of resistance, the C-reactive protein (CRP) presented an AUC ROC = 0.789, optimal cut-off value 15.1 mg/dL, sensitivity (Sn) 77.8% and specificity (Sp) 78.9%. The erythrocyte sedimentation rate (ESR) presented an AUC ROC = 0.781, optimal cut-off value 90.5 mm/h, Sn 66.7% and Sp 85.7%. The model with the two variables showed p = 0.042 and AUC ROC = 0.790. Predictive strength of Japanese models were: Kobayashi (Sn 63.6%, Sp 77.3%), Egami (Sn 66.7%, Sp 73.1%), Sano (Sn 28.6%, Sp 94.1%). CONCLUSION CRP and ESR are independent variables that were related to IVIG resistance, with optimal cut-off points of 15.1 mg/dL and 90.5 mm/h, respectively. About half of the patients had some form of cardiac involvement. The Japanese models appeared to be inadequate in our population. (Arq Bras Cardiol. 2021; 116(3):485-491).
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Affiliation(s)
- Diogo Faim
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal,Correspondência: Diogo Faim • Centro Hospitalar e Universitário de Coimbra EPE - Praceta, R. Prof. Mota Pinto, 3075 Coimbra 3000-075 – Portugal. E-mail:
| | - Cláudio Henriques
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
| | - Ana Brett
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Urgência e Unidade de Infeciologia, Coimbra - Portugal
| | - Andreia Francisco
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
| | - Fernanda Rodrigues
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Urgência e Unidade de Infeciologia, Coimbra - Portugal
| | - António Pires
- Centro Hospitalar e Universitário de Coimbra EPECoimbraPortugalCentro Hospitalar e Universitário de Coimbra EPE - Cardiologia Pediátrica, Coimbra - Portugal
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Marchesi A, Rigante D, Cimaz R, Ravelli A, Tarissi de Jacobis I, Rimini A, Cardinale F, Cattalini M, De Zorzi A, Dellepiane RM, Salice P, Secinaro A, Taddio A, Palma P, El Hachem M, Cortis E, Maggio MC, Corsello G, Villani A. Revised recommendations of the Italian Society of Pediatrics about the general management of Kawasaki disease. Ital J Pediatr 2021; 47:16. [PMID: 33494789 PMCID: PMC7830049 DOI: 10.1186/s13052-021-00962-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Aim of these revised recommendations for the general management of Kawasaki disease is to encourage its prompter recognition and warrant the most appropriate therapy, based on ascertained scientific data, raising awareness of the complications related to misdiagnosis or delayed treatment. A set of 20 synthetic operative statements is herein provided, including the definition of Kawasaki disease, its protean presentations, clinical course and seminal treatment modalities of all disease phases. The application of these recommendations should improve prognosis of Kawasaki disease and prevent the progression to permanent vascular abnormalities, thereby diminishing morbidity and mortality.
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Affiliation(s)
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Università Cattolica Sacro Cuore, Rome, Italy
| | - Rolando Cimaz
- Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy. .,University of Milan, Milan, Italy.
| | - Angelo Ravelli
- Pediatrics and Rheumatology Unit, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | | | | | - Fabio Cardinale
- Department of Pediatrics, AOU Policlinico Giovanni XXIII, Bari, Italy
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Rosa Maria Dellepiane
- UOC of Pediatrics, UOS of Pediatric Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Salice
- Section of Pediatric Cardiovascular Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Andrea Taddio
- University of Trieste, Trieste, Italy.,Institute of Child and Maternal Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Paolo Palma
- Bambino Gesù Children's Hospital, Rome, Italy
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23
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Huang CY, Chiu NC, Huang FY, Chao YC, Chi H. Prediction of Coronary Artery Aneurysms in Children With Kawasaki Disease Before Starting Initial Treatment. Front Pediatr 2021; 9:748467. [PMID: 34660496 PMCID: PMC8515030 DOI: 10.3389/fped.2021.748467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Precisely predicting coronary artery aneurysms (CAAs) remains a clinical challenge. We aimed to investigate whether coronary dimensions adjusted for body surface area (Z scores) on baseline echocardiography and clinical variables before primary treatment could predict the presence of late CAAs. Methods: We conducted a retrospective study including children hospitalized for Kawasaki disease and received intravenous immunoglobulin within 10 days of illness. We defined late CAAs as a maximum Z score (Zmax) ≥2.5 of the left main, right, or left anterior descending coronary artery at 11-60 days of illness. Associations between late CAAs and clinical parameters and baseline maximum Z scores were analyzed. Results: Among the 314 included children, 31 (9.9%) had late CAAs. Male, higher C-reactive protein, and higher baseline Zmax were risk factors of late CAAs. Late CAAs were significantly associated with baseline Zmax ≥2.0 vs. <2.0 (25 [32.5%] vs. 6 [2.5%], P < 0.001). The odds ratio for late CAAs among the patients with baseline Zmax ≥2.0 vs. <2.0 was 18.5 (95% confidence interval, 7.23 to 47.41, P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of baseline Zmax ≥2.0 for the presence of later CAAs were 80.6, 81.6, 32.5, and 97.5%, respectively. Conclusions: Findings from this study suggest that Zmax ≥2.0 of coronary arteries on baseline echocardiography may be used to predict children at a high risk of late CAAs and allow for targeted early intensification therapy.
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Affiliation(s)
- Ching-Ying Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
| | - Fu-Yuan Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Yen-Chun Chao
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital, Taipei City, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan.,Department of Pediatrics, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
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24
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Predictive value of heart rate deceleration capacity on coronary artery lesion in acute phase of Kawasaki disease. Sci Rep 2020; 10:10211. [PMID: 32576944 PMCID: PMC7311450 DOI: 10.1038/s41598-020-67121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
This study was to investigate the correlation of vagal activity with coronary artery lesion (CAL) in Kawasaki disease (KD) children, and assess the predictive value of heart rate deceleration capacity (DC) for CAL in acute phase of KD.50 KD children with CAL, 130 KD children without CAL, 30 children with acute upper respiratory infection and 100 healthy children were recruited and indicators reflecting vagal activity including DC were measstuogram. KD children with CAL showed decreased vagal activity with significantly lower values of DC. DC was negatively correlated with levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) in KD children. DC was a usable cardiac electrophysiological index to predict CAL in children with KD, with an area under the receiver operating characteristic curve (AUC) of 0.741. The cut-off value of DC for predicting CAL in KD children was 4.37 ms. DC was an independent predictor of CAL in children with KD, evaluated by multiple logistic regression analysis, KD children with DC ≤ 4.37 ms had an increased risk of CAL, with odds ratios (OR) of 5.94. Our study illustrates DC could be used to predict CAL in acute phase of KD.
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25
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Abstract
BACKGROUND Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area. METHODS AND RESULTS All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active. CONCLUSION In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.
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26
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Kawasaki disease with giant aneurysm of left coronary artery and complete occlusion of right coronary artery. Cardiol Young 2020; 30:580-581. [PMID: 32129733 DOI: 10.1017/s1047951120000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Kawasaki disease is an acute febrile medium-vessel vasculitis affecting children. Though coronary artery aneurysm is a common complication, stenosis and occlusion are rare. Here, we report a case of Kawasaki disease with concomitant aneurysm and complete occlusion of different coronary arteries in the same patient.
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27
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Zhang D, Liu L, Huang X, Tian J. Insights Into Coronary Artery Lesions in Kawasaki Disease. Front Pediatr 2020; 8:493. [PMID: 32984207 PMCID: PMC7477115 DOI: 10.3389/fped.2020.00493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
This review summarizes recent advances in understanding the development of coronary arteritis in Kawasaki disease. Kawasaki disease is the most common cause of acquired heart disease among children characterized with coronary artery abnormalities, which can cause myocardial ischemia, infarction, and even death. The pathogenic factors of Kawasaki disease and the pathological process of coronary artery disease are not clear at present, which brings challenges to the prevention and treatment of the disease. The treatment of Kawasaki disease focuses mainly on timely administration of intravenous high doses of immunoglobulin and aspirin. However, there are still some patients who do not respond well to this standard treatment, and its management remains a challenge. As a result, coronary artery lesions still occur in patients and affect their quality of life. In this review, we discuss updated research data of Kawasaki disease coronary artery lesions.
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Affiliation(s)
- Danfeng Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingjuan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xupei Huang
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Jie Tian
- Ministry of Education Key Laboratory of Child Development and Disorders, Department of Cardiology, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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28
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Ozdemir E, Peterson RE. Systemic arterial aneurysm complicated by thrombosis in an infant with resistant Kawasaki disease. Ann Pediatr Cardiol 2019; 12:147-149. [PMID: 31143043 PMCID: PMC6521662 DOI: 10.4103/apc.apc_73_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis commonly associated with coronary artery aneurysms. Small-sized and medium-sized systemic arterial aneurysms have also been described, particularly in infants and patients with resistant KD. This case illustrates the presentation of a systemic arterial aneurysm complicated by arterial thrombosis and successful interventional management in a young infant.
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Affiliation(s)
- Ege Ozdemir
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Renuka E Peterson
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
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29
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Cameron SA, Carr M, Pahl E, DeMarais N, Shulman ST, Rowley AH. Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease. Arch Dis Child 2019; 104:451-455. [PMID: 30413485 DOI: 10.1136/archdischild-2018-314967] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/21/2018] [Accepted: 10/11/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We aimed to compare the severity of coronary artery abnormalities in Kawasaki disease between infants and older children. METHODS We retrospectively reviewed and compared coronary artery dilation and aneurysm severity in infants <1 year of age with Kawasaki disease at our centre over a 10-year period with that observed in children ≥1 year of age in the Pediatric Heart Network Trial of Pulse Steroid Therapy in Kawasaki Disease. Coronary artery abnormalities were defined by z-scores according to American Heart Association guidelines. RESULTS Of the 93 infants identified during the study period, 80 were treated with intravenous gamma globulin within the first 10 days of illness and were included for comparison to 170 children ≥1 year of age treated in the same time frame from the Pediatric Heart Network public database. The mean maximum z-score was significantly higher in infants compared with older children (3.37 vs 2.07, p<0.001). A higher incidence of medium and giant aneurysms was observed in infants compared with children ≥1 year of age (11% vs 3% for medium aneurysms, p=0.015; 8% vs <1% for giant aneurysms, p=0.005). CONCLUSIONS Infants with Kawasaki disease have more severe coronary artery dilation compared with older children, and a higher prevalence of medium and giant aneurysms. Because adverse outcomes are closely linked to the maximal coronary artery diameter in Kawasaki disease, patients diagnosed as infants require very close long-term monitoring for cardiac complications.
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Affiliation(s)
- Scott A Cameron
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Carr
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Elfriede Pahl
- Division of Cardiology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Stanford T Shulman
- Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Anne H Rowley
- Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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30
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Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. N-terminal probrain natriuretic peptide as biomarker for diagnosis of Kawasaki disease. Biomark Med 2019; 13:307-323. [PMID: 30900472 DOI: 10.2217/bmm-2018-0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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31
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Matundan HH, Sin J, Rivas MN, Fishbein MC, Lehman TJ, Chen S, Gottlieb RA, Crother TR, Abe M, Arditi M. Myocardial fibrosis after adrenergic stimulation as a long-term sequela in a mouse model of Kawasaki disease vasculitis. JCI Insight 2019; 4:126279. [PMID: 30728329 DOI: 10.1172/jci.insight.126279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
Kawasaki disease (KD), the leading cause of acquired cardiac disease among children, is often associated with myocarditis that may lead to long-term myocardial dysfunction and fibrosis. Although those myocardial changes develop during the acute phase, they may persist for decades and closely correlate with long-term myocardial sequelae. Using the Lactobacillus casei cell wall extract-induced (LCWE-induced) KD vasculitis murine model, we investigated long-term cardiovascular sequelae, such as myocardial dysfunction, fibrosis, and coronary microvascular lesions following adrenergic stimuli after established KD vasculitis. We found that adrenergic stimulation with isoproterenol following LCWE-induced KD vasculitis in mice was associated with increased risk of cardiac hypertrophy and myocardial fibrosis, diminished ejection fraction, and increased serum levels of brain natriuretic peptide. Myocardial fibrosis resulting from pharmacologic-induced exercise after KD development was IL-1 signaling dependent and was associated with a significant reduction in myocardial capillary CD31 expression, indicative of a rarefied myocardial capillary bed. These observations suggest that adrenergic stimulation after KD vasculitis may lead to cardiac hypertrophy and bridging fibrosis in the myocardium in the LCWE-induced KD vasculitis mouse model and that this process involves IL-1 signaling and diminished microvascular circulation in the myocardium.
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Affiliation(s)
- Harry H Matundan
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology
| | - Jon Sin
- Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and
| | - Magali Noval Rivas
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Michael C Fishbein
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Thomas J Lehman
- Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York, USA
| | - Shuang Chen
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Roberta A Gottlieb
- Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and
| | - Timothy R Crother
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
| | - Masanori Abe
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology
| | - Moshe Arditi
- Departments of Biomedical Sciences and Pediatrics, Divisions of Infectious Diseases and Immunology.,Cedars-Sinai Heart Institute, Barbra Streisand Women's Heart Center, and.,Infectious and Immunologic Diseases Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Pediatrics and
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32
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de La Harpe M, di Bernardo S, Hofer M, Sekarski N. Thirty Years of Kawasaki Disease: A Single-Center Study at the University Hospital of Lausanne. Front Pediatr 2019; 7:11. [PMID: 30761279 PMCID: PMC6363689 DOI: 10.3389/fped.2019.00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease is an acute vasculitis with a particular involvement of the coronary arteries. Coronary artery aneurysms develop in 20% of untreated children. It has been shown that early treatment with intravenous immunoglobulins and aspirin decreases this risk to 5%, but the medium to long term prognosis of children with Kawasaki disease is still unclear. To determine the outcome of the disease and risk factors for poor evolution, we reviewed retrospectively the medical records of all patients with a diagnosis of Kawasaki disease at our Institution between 1981 and 2014. Among the 207 patients included in the study, 96 patients had coronary diameter anomalies (46.4%) at diagnosis and children with atypical ages for Kawasaki disease (<1 year or >10 year of age) were more often affected with aneurysms or dilatations. Eighty-four of them had complete regression of coronary aneurysms during the follow-up (87.5%) Absence of immunoglobulins in the acute phase was associated with less regression rate (57.1 vs. 92.2%), and boys had greater z-scores at last echocardiography, statistically significant for the left anterior descending artery. We found rare complications after the acute phase documented in our patient charts (only 3.8%). Recurrence of the disease occurred in 5 children (2.4%) and myocardial ischemia in 3 patients (1.4%), all with initial coronary aneurysm. Conclusion: Medium to long term prognosis after Kawasaki disease is excellent. Boys, patients not treated with immunoglobulins or outside the usual age range are more at risk for an unfavorable outcome.
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Affiliation(s)
- Marion de La Harpe
- Pediatric Cardiology Unit, University of Lausanne, Lausanne, Switzerland
| | - Stefano di Bernardo
- Pediatric Cardiology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Michaël Hofer
- Pediatric Rheumatology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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33
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Marsaud C, Koné-Paut I. [Not Available]. JOURNAL DE PEDIATRIE ET DE PUERICULTURE 2018; 31:225-234. [PMID: 32288395 PMCID: PMC7146770 DOI: 10.1016/j.jpp.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
La maladie de Kawasaki, bien connue des pédiatres, est une vascularite multisystémique aiguë touchant les vaisseaux de moyens calibres avec une prédilection pour les artères coronaires. Dans les pays développés, cette maladie est la première cause de cardiopathie acquise chez l’enfant. La physiopathologie de cette maladie est actuellement toujours inconnue, mais il est communément admis qu’un ou plusieurs agents infectieux induisent une réponse inflammatoire inappropriée chez un sujet génétiquement prédisposé. Le diagnostic est clinique et doit être évoqué chez des enfants présentant une fièvre prolongée de plus de cinq jours avec un syndrome inflammatoire biologique. Des critères cliniques d’inflammation cutanéomuqueuse ont été définis par l’American Heart Association en 2004 afin d’établir le diagnostic. Cependant, certains enfants peuvent présenter des formes incomplètes de la maladie surtout lorsque la maladie apparaît à un âge inhabituel. Les symptômes sont proches de certaines pathologies infectieuses de l’enfant comme la scarlatine ou une infection virale rendant le diagnostic difficile. Par ailleurs, un retard au diagnostic ou l’absence de traitement majore le risque de développer des anévrismes coronaires. Les immunoglobulines polyvalentes constituent le traitement de première ligne, avec un taux de succès de l’ordre de 80 %. En cas de non-réponse à cette première ligne de traitement, le recours aux corticoïdes peut être proposé, en association à une deuxième cure d’immunoglobulines, surtout dans les formes de mauvais pronostic. D’autres thérapeutiques comme les anti-tumor necrosis factor alpha ou certains immunosuppresseurs peuvent aussi être employées en cas de résistance aux immunoglobulines, mais doivent être discutées avec une équipe spécialisée.
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Affiliation(s)
- C Marsaud
- Hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - I Koné-Paut
- Hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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34
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Marchesi A, Tarissi de Jacobis I, Rigante D, Rimini A, Malorni W, Corsello G, Bossi G, Buonuomo S, Cardinale F, Cortis E, De Benedetti F, De Zorzi A, Duse M, Del Principe D, Dellepiane RM, D'Isanto L, El Hachem M, Esposito S, Falcini F, Giordano U, Maggio MC, Mannarino S, Marseglia G, Martino S, Marucci G, Massaro R, Pescosolido C, Pietraforte D, Pietrogrande MC, Salice P, Secinaro A, Straface E, Villani A. Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I - definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase. Ital J Pediatr 2018; 44:102. [PMID: 30157897 PMCID: PMC6116535 DOI: 10.1186/s13052-018-0536-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
The primary purpose of these practical guidelines related to Kawasaki disease (KD) is to contribute to prompt diagnosis and appropriate treatment on the basis of different specialists’ contributions in the field. A set of 40 recommendations is provided, divided in two parts: the first describes the definition of KD, its epidemiology, etiopathogenetic hints, presentation, clinical course and general management, including treatment of the acute phase, through specific 23 recommendations. Their application is aimed at improving the rate of treatment with intravenous immunoglobulin and the overall potential development of coronary artery abnormalities in KD. Guidelines, however, should not be considered a norm that limits treatment options of pediatricians and practitioners, as treatment modalities other than those recommended may be required as a result of peculiar medical circumstances, patient’s condition, and disease severity or complications.
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Affiliation(s)
- Alessandra Marchesi
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy.
| | | | - Donato Rigante
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | | | | | | | | | - Sabrina Buonuomo
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | - Fabrizio De Benedetti
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | - Andrea De Zorzi
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | - Marzia Duse
- , Università degli Studi Sapienza, Rome, Italy
| | | | | | | | - Maya El Hachem
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | - Ugo Giordano
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | | | | | - Giulia Marucci
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | | | | | | | | | - Aurelio Secinaro
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
| | | | - Alberto Villani
- Bambino Gesù Children's Hospital, Rome, Italy, Piazza S. Onofrio n. 4, 00165, Rome, Italy
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35
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Martin M, Wrotniak BH, Hicar M. Suppressed plasmablast responses in febrile infants, including children with Kawasaki disease. PLoS One 2018; 13:e0193539. [PMID: 29579044 PMCID: PMC5868766 DOI: 10.1371/journal.pone.0193539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/13/2018] [Indexed: 12/24/2022] Open
Abstract
Background Kawasaki disease (KD), the leading cause of acquired heart disease in children, primarily affects infants and toddlers. Investigations on immune responses during KD are hampered by a limited understanding of normal immune responses in these ages. It’s well known that Infants have poorer vaccine responses and difficulty with maintaining prolonged serum immunity, but there are few studies on human infants detailing immune deficiencies. Limited studies propose an inability to maintain life-long bone marrow plasma cells. Plasmablasts are a transitional cell form of B cells that lead to long-term Plasma cells. Plasmablasts levels rise in the peripheral blood after exposure to a foreign antigen. In adult studies, these responses are both temporally and functionally well characterized. To date, there have been few studies on plasmablasts in the predominant age range of KD. Methods Children presenting to an urban pediatric emergency room undergoing laboratory evaluation, who had concern of KD or had fever and symptoms overlapping those of KD, were recruited. Peripheral blood mononuclear cells were isolated and evaluated utilizing flow cytometry with specific B cell markers from 18 KD subjects and 69 febrile controls. Results Plasmablast numbers and temporal formation are similar between infectious disease controls and KD subjects. In both groups, infants have diminished plasmablast responses compared to older children. Conclusion In this single-time point survey, infants have a blunted peripheral plasmablast response. Overall, similar plasmablast responses in KD and controls support an infectious disease relationship to KD. Future time-course studies of plasmablasts in infants are warranted as this phenomenon may contribute to observed immune responses in this age group.
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Affiliation(s)
- Meghan Martin
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Brian H. Wrotniak
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Mark Hicar
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- * E-mail:
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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians. Autoimmun Rev 2018; 17:201-214. [DOI: 10.1016/j.autrev.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
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Kawasaki Disease Substantially Impacts Health-Related Quality of Life. J Pediatr 2018; 193:155-163.e5. [PMID: 29198542 DOI: 10.1016/j.jpeds.2017.09.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/20/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To prospectively evaluate the acute impact of Kawasaki disease (KD) on health-related quality of life (HRQoL) and to assess deterioration in the HRQoL experienced by children with KD compared with other childhood diseases. STUDY DESIGN We merged the Outcomes Assessment Program database obtained prospectively with the existing KD database and queried for KD admissions between 1 month and 13 years of age. HRQoL was evaluated with the parent-proxy Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core and Infant Scales. We compared the KD HRQoL results with those obtained from newly diagnosed patients with cancer and pneumonia, matched for age, sex and race. PedsQL total scores over time were assessed with ANCOVA models, adjusted for matching variables and PedsQL score prior to admission. RESULTS We identified 89 patients with KD and compared 65 subjects with an equal number with pneumonia and with 67 subjects with newly diagnosed cancer. Patients with demonstrated lower PedsQL total score on admission and suffered a significantly greater HRQoL decline from baseline to admission than the other groups. KD diagnostic subtype (complete or incomplete) and coronary artery dilatation were not associated with HRQoL outcomes. However, non-intravenous immunoglobulin responders showed greater HRQoL decline than responders (P = .03). CONCLUSIONS Children with KD suffer acute and significant HRQoL impairment exceeding that of children newly diagnosed with cancer. Lack of immediate treatment response may exert an additional HRQoL burden, whereas KD subtype and coronary artery dilatation do not.
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Affiliation(s)
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA
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Coronary artery aneurysm regression after Kawasaki disease and associated risk factors: a 3-year follow-up study in East China. Clin Rheumatol 2018; 37:1945-1951. [PMID: 29330741 DOI: 10.1007/s10067-018-3977-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease due to its complicated coronary artery lesions. Up to now, few studies were focused on the status of persistent coronary artery aneurysms (CAA) in KD patients. The present study was designed to identify the coronary artery outcomes and seek the risk factors associated with the regression of CAA in KD patients. One hundred and twenty KD patients with CAA hospitalized in Children's Hospital of Soochow University from Jan 2008 to Dec 2013 were prospectively studied by a 3-year follow-up. Data regarding demographic, clinical, laboratory, and echocardiographic characteristics were documented and further analyzed. It was estimated that 39.2% of the patients had complete regression of CAA within 4 weeks, 59.2% within 8 weeks, and 70.0% within 16 weeks. No fatal cardiac events occurred. We found patients who aged ≤ 1 year, received initial intravenous immunoglobulin (IVIG) treatment after the 10th day of illness, and IVIG non-responders were associated with the regression of persistent CAA. The relative risks were 1.55, 1.87, and 1.88, respectively. Age, initial IVIG treatment, and IVIG response were risk factors of persistent CAA, and more attention should be paid on these patients.
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Sag E, Batu ED, Ozen S. Childhood systemic vasculitis. Best Pract Res Clin Rheumatol 2017; 31:558-575. [PMID: 29773273 DOI: 10.1016/j.berh.2017.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 01/19/2023]
Abstract
Vasculitides are characterized by inflammation of the vessel wall. Most of the vasculitides tend to occur in vessels of a specific size and certain target organs. In this review, we discuss each specific childhood vasculitis according to the latest Chapel Hill Consensus Conference 2012 nomenclature system and the Ankara 2008 classification criteria. We have also reviewed the clinical and laboratory characteristics and the recent treatment recommendations for the vasculitides we encounter in children.
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Affiliation(s)
- Erdal Sag
- Hacettepe University, Ihsan Dogramaci Children's Hospital, Department of Pediatric Rheumatology, Turkey
| | - Ezgi Deniz Batu
- Hacettepe University, Ihsan Dogramaci Children's Hospital, Department of Pediatric Rheumatology, Turkey
| | - Seza Ozen
- Hacettepe University, Ihsan Dogramaci Children's Hospital, Department of Pediatric Rheumatology, Turkey.
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Chen KYH, Curtis N, Cheung M, Burgner D. Cardiovascular Risk After Kawasaki Disease - Findings From an Australian Case-Control Study. Heart Lung Circ 2017; 27:6-8. [PMID: 29198833 DOI: 10.1016/s1443-9506(17)31473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Katherine Y H Chen
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia; Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital, Parkville, Vic, Australia
| | - Nigel Curtis
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia; Infectious Diseases Unit and Department of General Medicine, The Royal Children's Hospital, Parkville, Vic, Australia
| | - Michael Cheung
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia; Heart Research Group, Murdoch Children's Research Institute and Department of Cardiology, The Royal Children's Hospital, Parkville, Vic, Australia
| | - David Burgner
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Vic, Australia; Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia; Department of Paediatrics, Monash University, Clayton, Vic, Australia.
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Charlesworth JM, Power B, Moylett E. Safety netting versus overtreatment in paediatrics: viral infection or incomplete Kawasaki disease? BMJ Case Rep 2017; 2017:bcr-2017-222323. [PMID: 29122906 PMCID: PMC5695529 DOI: 10.1136/bcr-2017-222323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kawasaki disease (KD) is the most common systemic vasculitis of childhood. The following presentation of a 4-year-old Irish boy referred to a secondary care paediatric service from the community with prolonged fever, oral mucous membrane changes and painless blistering lesions of the hands and feet in the presence of elevated inflammatory markers serves as an opportunity to discuss the diagnostic criteria and treatment for KD and incomplete KD, an often missed diagnosis with significant paediatric morbidity outside an academic paediatric centre.
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Affiliation(s)
| | - Bernadette Power
- Department of Paediatrics, Letterkenny General Hospital, Letterkenny, Donegal, Ireland
| | - Edina Moylett
- Department of Paediatrics, University College Hospital Galway, Galway, Ireland
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Denby KJ, Clark DE, Markham LW. Management of Kawasaki disease in adults. Heart 2017; 103:1760-1769. [DOI: 10.1136/heartjnl-2017-311774] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
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Szalay Z, Papantchev V, Walther T. Aortic root aneurysm extending into the arch as a rare complication of Kawasaki disease: surgical management. Eur J Cardiothorac Surg 2017; 51:799-801. [PMID: 28040678 DOI: 10.1093/ejcts/ezw379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 11/13/2022] Open
Abstract
An aortic aneurysm complicating Kawasaki disease (KD) is extremely rare. We herein report a case of 48-year-old KD patient with severe aortic regurgitation, aneurysm of the aortic root, ascending aorta and aortic arch, and giant heavily calcified coronary aneurysms. The patient underwent successful surgical management. This case raises some unusual technical issues, which are discussed. A review of the literature is also offered.
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Affiliation(s)
- Zoltan Szalay
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Vassil Papantchev
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2083] [Impact Index Per Article: 297.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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Friedman KG, Gauvreau K, Hamaoka-Okamoto A, Tang A, Berry E, Tremoulet AH, Mahavadi VS, Baker A, deFerranti SD, Fulton DR, Burns JC, Newburger JW. Coronary Artery Aneurysms in Kawasaki Disease: Risk Factors for Progressive Disease and Adverse Cardiac Events in the US Population. J Am Heart Assoc 2016; 5:JAHA.116.003289. [PMID: 27633390 PMCID: PMC5079009 DOI: 10.1161/jaha.116.003289] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The natural history of coronary artery aneurysms (CAA) after intravenous immunoglobulin (IVIG) treatment in the United States is not well described. We describe the natural history of CAA in US Kawasaki disease (KD) patients and identify factors associated with major adverse cardiac events (MACE) and CAA regression. Methods and Results We evaluated all KD patients with CAA at 2 centers from 1979 to 2014. Factors associated with CAA regression, maximum CA z‐score over time (zMax), and MACE were analyzed. We performed a matched analysis of treatment effect on likelihood of CAA regression. Of 2860 KD patients, 500 (17%) had CAA, including 90 with CAA z‐score >10. Most (91%) received IVIG within 10 days of illness, 32% received >1 IVIG, and 27% received adjunctive anti‐inflammatory medications. CAA regression occurred in 75%. Lack of CAA regression and higher CAA zMax were associated with earlier era, larger CAA z‐score at diagnosis, and bilateral CAA in univariate and multivariable analyses. MACE occurred in 24 (5%) patients and was associated with higher CAA z‐score at diagnosis and lack of IVIG treatment. In a subset of patients (n=132) matched by age at KD and baseline CAA z‐score, those receiving IVIG plus adjunctive medication had a CAA regression rate of 91% compared with 68% for the 3 other groups (IVIG alone, IVIG ≥2 doses, or IVIG ≥2 doses plus adjunctive medication). Conclusions CAA regression occurred in 75% of patients. CAA z‐score at diagnosis was highly predictive of outcomes, which may be improved by early IVIG treatment and adjunctive therapies.
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Affiliation(s)
- Kevin G Friedman
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberly Gauvreau
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Alexander Tang
- Department of Cardiology, Children's Hospital Boston, Boston, MA
| | - Erika Berry
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Vidya S Mahavadi
- Department of Pediatrics, University of California San Diego, La Jolla, CA Rady Children's Hospital San Diego, San Diego, CA
| | - Annette Baker
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Sarah D deFerranti
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David R Fulton
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jane C Burns
- Department of Pediatrics, Harvard Medical School, Boston, MA Rady Children's Hospital San Diego, San Diego, CA
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
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Hassidim A, Merdler I, Chorin O, Merdler-Rabinowicz R, Dallal I, Perlman M, Chorin E. Atopic Predilection among Kawasaki Disease Patients: A Cross-Sectional Study of 1,187,757 Teenagers. Int Arch Allergy Immunol 2016; 170:92-6. [PMID: 27437950 DOI: 10.1159/000447639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute, systemic vasculitis in children, with an etiology that is not completely understood. It is assumed that the development of KD is mediated by an immunologic response. Several reports from East Asia have found a higher prevalence of atopic diseases among patients with KD, but a large-scale study of a non-Asian population regarding this correlation is still lacking. The purpose of this article was to achieve this goal. METHODS We conducted a cross-sectional, large-scale study to estimate the correlation of KD with allergic diseases. The medical history of 1,187,757 Israeli teenagers (aged 16-20 years during the years 1998-2013) was retrieved. The study population was divided into 3 groups according to a past history of noncomplicated and complicated KD and a control group. The prevalence of allergic diseases among these groups was further investigated. RESULTS The prevalence of atopic diseases in the 3 study groups was presented (asthma in 11.4, 8.1 and 3.5%, respectively; angioedema/urticaria in 7.1, 0 and 0.46%, respectively; allergic rhinitis in 20, 12.1 and 6.7%, respectively). In noncomplicated KD, a statistically significant link to asthma [odds ratio (OR) 2.4; p = 0.048] and a borderline significant link to allergic rhinitis (OR 1.9; p = 0.06) were found. In KD complicated with cardiac disease, statistically significant links were found for all the allergic conditions, asthma (OR 3.5; p = 0.003), allergic rhinitis (OR 3.5; p < 0.001) and angioedema/urticaria (OR 16.48; p < 0.001). CONCLUSION KD is associated with allergic diseases. This association increases with the severity of the disease.
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Affiliation(s)
- Ayal Hassidim
- Department of Plastic and Reconstructive Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Abstract
Kawasaki disease (KD) is an acute childhood febrile disease of unknown etiology. It exhibits not only coronary artery aneurysms in some cases but also systemic vasculitis. Whether KD is associated with accelerated atherosclerosis remains debatable. The measurement of pulse wave velocity (PWV) is useful as a simple, noninvasive measurement of arterial stiffness, an atherosclerotic manifestation. We herein present a systematic review of clinical studies that focused on PWV in patients with KD. A PubMed-based search identified 8 eligible studies published until June 2015. The PWV of patients with KD, regardless of antecedent coronary artery lesions, was high relative to controls, even though their blood pressure appeared to be similar. Although definitive conclusions cannot be made with the limited information, patients with KD may be at risk of systemic atherosclerosis in association with arterial stiffness. Further research, including longitudinal and outcome studies, is needed to determine the clinical significance of a potential increase in PWV in patients with KD.
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Affiliation(s)
- Yoshitaka Iwazu
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
| | - Takaomi Minami
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Kotani
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Tochigi, Japan
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Chen KYH, Curtis N, Dahdah N, Kowalski R, Cheung M, Burgner DP. Kawasaki disease and cardiovascular risk: a comprehensive review of subclinical vascular changes in the longer term. Acta Paediatr 2016; 105:752-61. [PMID: 26880292 DOI: 10.1111/apa.13367] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/12/2016] [Indexed: 01/25/2023]
Abstract
UNLABELLED Studies of subclinical vascular changes post-Kawasaki disease indicate that, in general, individuals with a history of coronary artery aneurysms have increased carotid intima-media thickness, evidence of endothelial dysfunction, and increased arterial stiffness, possibly indicative of heightened cardiovascular risk. The results are less consistent for low-risk groups. CONCLUSION Until data are available from larger prospective studies, it is prudent to advise families of individuals with a history of Kawasaki disease to minimise traditional modifiable cardiovascular risk factors.
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Affiliation(s)
- Katherine Y. H. Chen
- Murdoch Childrens Research Institute; The Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; The University of Melbourne; Parkville Vic. Australia
- Department of General Medicine; The Royal Children's Hospital; Melbourne Vic. Australia
| | - Nigel Curtis
- Murdoch Childrens Research Institute; The Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; The University of Melbourne; Parkville Vic. Australia
- Department of General Medicine; The Royal Children's Hospital; Melbourne Vic. Australia
| | - Nagib Dahdah
- Division of Pediatric Cardiology; CHU Ste-Justine; University of Montreal; Montreal QC Canada
| | - Remi Kowalski
- Heart Research Group, Murdoch Childrens Research Institute and Department of Cardiology; The Royal Children's Hospital; Melbourne Vic. Australia
| | - Michael Cheung
- Department of Paediatrics; The University of Melbourne; Parkville Vic. Australia
- Heart Research Group, Murdoch Childrens Research Institute and Department of Cardiology; The Royal Children's Hospital; Melbourne Vic. Australia
| | - David P. Burgner
- Murdoch Childrens Research Institute; The Royal Children's Hospital; Melbourne Vic. Australia
- Department of Paediatrics; The University of Melbourne; Parkville Vic. Australia
- Department of Paediatrics; Monash University; Clayton Vic Australia
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Gordon JB, Daniels LB, Kahn AM, Jimenez-Fernandez S, Vejar M, Numano F, Burns JC. The Spectrum of Cardiovascular Lesions Requiring Intervention in Adults After Kawasaki Disease. JACC Cardiovasc Interv 2016; 9:687-96. [DOI: 10.1016/j.jcin.2015.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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