Cardiac Events and the Maximum Diameter of Coronary Artery Aneurysms in Kawasaki Disease

Tsuda, Etsuko; Tsujii, Nobuyuki; Hayama, Yosuke

doi:10.1016/j.jpeds.2017.05.055

Cited by 22 publications

(21 citation statements)

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“…Our study demonstrates that infants with KD have a higher severity of coronary artery dilation compared with children ≥1 year of age. It has been clearly demonstrated that risk of adverse clinical outcomes from CAAs in KD is directly related to the maximal CAA diameter during the acute phase 10 11. In our study, 13% (12/93) of infants developed medium CAAs (z-score ≥5 to <10) and 12% (11/93) developed giant CAAs (z-score >10), indicating that these patients are at significant risk for long-term adverse outcomes.…”

Section: Discussionmentioning

confidence: 47%

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

et al. 2018

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ObjectiveWe aimed to compare the severity of coronary artery abnormalities in Kawasaki disease between infants and older children.MethodsWe 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.ResultsOf 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).ConclusionsInfants 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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Section: Discussionmentioning

confidence: 47%

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

et al. 2018

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“…Coronary-artery aneurysms change in morphology over many years. Acute myocardial infarction often occurs in patients with giant aneurysms (≥8 mm in diameter) within the first year of onset of acute KD, which leads to left ventricular dysfunction or sudden death [5,6]. Severe localized stenosis due to coronary wall thickening after KD can cause myocardial ischemia [7].…”

Section: Coronary-artery Lesions Caused By Kdmentioning

confidence: 99%

Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease

Kitamura

Tsuda

2019

Children

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As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications.

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“…This study adds to an increasing body of evidence that CAA size during the initial stages of illness is the primary determinant of coronary outcomes. [7][8][9] Here, infants and small children (BSA <0.5 m 2 ) with a CAA dimension between 6 and 8 mm early in the illness had an equivalent cardiac event risk to that of a CAA of ≥8 mm. These data suggest that the classic definition of giant CAA (internal lumen dimension of ≥8 mm), often used for natural history studies in the Japanese literature, might be modified to ≥6 mm in children with a BSA of ≤0.5 m 2 .…”

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confidence: 92%

“…4,6 Even with timely IVIG therapy, 0.5% to 1.0% of patients develop a large or giant CAA, and constitute the group at highest risk for myocardial infarction, heart failure, and death. [7][8][9] Indeed, in the largest Japanese study to follow patients with giant CAA, cardiac event-free survival at 30 years was only 36%. 7 To prevent the progression of coronary enlargement and resulting complications, children with high-risk features often receive adjunctive anti-inflammatory therapies and undergo more frequent echocardiographic surveillance.…”

mentioning

confidence: 99%

“…The natural history of CAAs is largely related to the maximal CAA size early in the disease course, as well as to the number of coronary artery segments involved. [4][5][6][7][8][9] Aneurysms often increase in dimension in the first 2 months after the onset of illness. When CAAs are small or even medium sized, they frequently regress or remodel to normal internal lumen diameter within 1-2 years of illness.…”

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confidence: 99%

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Coronary Stenosis after Kawasaki Disease: Size Matters

Friedman

2018

The Journal of Pediatrics

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Cardiac Events and the Maximum Diameter of Coronary Artery Aneurysms in Kawasaki Disease

Cited by 22 publications

References 13 publications

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

Coronary artery aneurysms are more severe in infants than in older children with Kawasaki disease

Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease

Coronary Stenosis after Kawasaki Disease: Size Matters

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