Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Tacke, Carline E.; Kuipers, Irene M.; Groenink, Maarten; Spijkerboer, Anje M.; Kuijpers, Taco W.

doi:10.1161/circimaging.111.965996

Cited by 67 publications

(34 citation statements)

References 35 publications

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“…This is in line with our earlier observations in a comparable patient population that, in general, no segmental wall motion abnormalities are present at long-term follow-up. 26 This encouraging result contrasts with some of the previous histopathologic studies that have indicated persistent changes after KD. It is generally assumed that myocarditis may occur in KD, and prior histopathologic studies indeed reported myocardial abnormalities during the acute phase but also during follow-up.…”

Section: Discussioncontrasting

confidence: 81%

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Evaluation of Cardiac Function by Magnetic Resonance Imaging During the Follow-Up of Patients With Kawasaki Disease

Tacke

Romeih

Kuipers

et al. 2013

Circ: Cardiovascular Imaging

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Background-Although histopathologic studies suggest persistent myocardial abnormalities after Kawasaki disease (KD), the long-term effects on cardiac function remain to be revealed. We investigated biventricular volumes, function, and the presence of myocardial fibrosis by cardiac magnetic resonance imaging during long-term follow-up of KD. Methods and Results-Sixty patients with a history of KD (mean age, 16.9 years; 67% men; median interval after KD onset, 11.6 years) and 20 healthy control subjects (mean age, 17.9 years; 55% men) 12 to 24 years of age underwent cardiac magnetic resonance imaging. Biventricular end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were determined. Volumetric measurements were indexed for body surface area. Late contrast enhancement was used to detect areas of myocardial fibrosis. Biventricular volumes and function did not differ significantly between patients and control subjects. There were also no significant differences between patients with and without a history of left ventricular dysfunction resulting from KD-associated myocarditis or between patients with and without coronary artery aneurysms.Only those with prior ischemic heart disease had a significantly lower left ventricular ejection fraction compared with unaffected KD cases (left ventricular ejection fraction, 51% versus 57%; P=0.012). Late contrast enhancement was observed in only 2 patients with severe coronary artery aneurysms and was typical for myocardial infarction. Conclusions-In this cardiac magnetic resonance imaging study evaluating the cardiac function of patients with KD at longterm follow-up, we did not observe a difference in cardiac function between KD patients and control subjects, except for a subgroup of patients with ischemic heart disease as a result of severe coronary artery pathology.

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Section: Discussioncontrasting

confidence: 81%

“…16 Prior CMRI studies in KD are limited and have focused mainly on the coronary artery sequelae. 26,[29][30][31][32] To date, 1 study by Mavrogeni et al 31 reported functional CMRI data of 20 patients with persistent CAAs. In all patients except 2 with prior myocardial infarction, the LVEF was found to be within normal values.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cardiac Function by Magnetic Resonance Imaging During the Follow-Up of Patients With Kawasaki Disease

Tacke

Romeih

Kuipers

et al. 2013

Circ: Cardiovascular Imaging

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“…A second study in the Netherlands, which used comprehensive MRI both for anatomic imaging and stress, applied CMRI during follow-up of 63 patients with KD using adenosine. 326 They identified 23 aneurysms in 15 patients, ischemia in 4, and scar in 5. In 6 of the 15 patients with aneurysms, the coronary artery abnormalities were not visualized with echocardiography, which suggests that comprehensive CMRI is a superior, noninvasive, and radiation-free imaging modality for long-term surveillance of these patients.…”

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confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,870

4,124

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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 longterm 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. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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“…Coronary CT angiography is highly sensitive and specific for diagnosing coronal lesions in ASO patients, with additional benefit of describing the etiology of the stenosis (69). However, the use of 3D whole heart b-SSFP CMR sequences is becoming more established in adult coronary artery disease imaging (34,70,71), and may play a role in imaging the coronaries in the future. Additionally, CMR can assess ventricular function through SSFP sequences and consequences of ischemic lesions detected through the use of stress perfusion imaging (72) (Fig.…”

Section: Cmr Evaluation Of Coronary Artery Problems In Pediatricsmentioning

confidence: 99%

Trends in pediatric cardiovascular magnetic resonance imaging

Ntsinjana

Tann

2013

Acta Radiol

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Cardiac magnetic resonance (CMR) imaging has significantly evolved over the last decade, becoming an integral part of the contemporary assessment of both congenital and acquired pediatric heart disease. Recent trends show that there is a growing interest in clinical applications and research in this field. An attempt to discuss the evolving technologies, techniques, and applications of CMR in pediatrics is not complete without understanding the current strengths of the modality. CMR complements readily available echocardiography, in many cases information from CMR can remove the need for invasive angiographic catheterization, and in other cases can be used to augment cardiac catheterisation.

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Cardiac Magnetic Resonance Imaging for Noninvasive Assessment of Cardiovascular Disease During the Follow-Up of Patients With Kawasaki Disease

Cited by 67 publications

References 35 publications

Evaluation of Cardiac Function by Magnetic Resonance Imaging During the Follow-Up of Patients With Kawasaki Disease

Evaluation of Cardiac Function by Magnetic Resonance Imaging During the Follow-Up of Patients With Kawasaki Disease

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Trends in pediatric cardiovascular magnetic resonance imaging

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