Coronary Artery Dimensions in Febrile Children Without Kawasaki Disease

Muniz, Juan-Carlos G.; Dummer, Kirsten; Gauvreau, Kimberlee; Colan, Steven D.; Fulton, David R.; Newburger, Jane W.

doi:10.1161/circimaging.112.000159

Cited by 81 publications

(61 citation statements)

References 17 publications

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“…The coronary artery abnormalities associated with KD can be differentiated from lesser degrees of dilation that may be rarely present with other febrile illnesses. 95 The prevalence of coronary artery abnormalities in a clinical trial of initial treatment was 23% at 4 weeks after enrollment, reduced to 8% with 4 infusions of low-dose IVIG. 126 In a subsequent trial of single high-dose IVIG, this was further reduced to ≈4%.…”

Section: Coronary Artery Abnormalitiesmentioning

confidence: 99%

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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

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2,876

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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Section: Coronary Artery Abnormalitiesmentioning

confidence: 99%

“…However, it is unclear whether such reductions in dimensions represent resolution of inflammatory changes in the arterial walls or hemodynamic or functional factors related to fever and circulating inflammatory mediators. 95,96 by guest on http://circ.ahajournals.org/…”

Section: Coronary Artery Abnormalitiesmentioning

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

Self Cite

2,876

4,124

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show abstract

“…A small sized pilot study reported that coronary artery dimensions in patients with febrile illness other than KD were significantly larger than in the afebrile normative population, but smaller than in KD patients. 17 The pathogenesis of coronary artery dilatation remains unknown in febrile disease states, but may be related to higher myocardial oxygen demand caused by fever and tachycardia. The subsequent increase in coronary blood flow results from compensatory dilation of the coronary arterys.…”

Section: Resultsmentioning

confidence: 99%

On What Day of Illness Does the Dilatation of Coronary Arteries in Patients With Kawasaki Disease Begin?

Fuse

Mori

Kuroiwa

et al. 2018

Circ J

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“…24 Clínicamente, se constata taquicardia sinusal, 25 precordio activo por miocarditis, ritmo de galope y soplo regurgitativo de insuficiencia mitral. Ocasionalmente, bajo gasto cardíaco y shock por disfunción ventricular grave.…”

Section: Evaluación Cardiológica 71 Manifestaciones Cardiovascularesunclassified

“…En caso de que este último fuera normal, el tercer ecocardiograma deberá realizarse entre las 6 y las 8 semanas desde el inicio de la EK. 12,25,31 En los pacientes en los que se detecta la presencia de aneurismas coronarios, derrame pericárdico, insuficiencia valvular, disfunción ventricular o persistencia de signos de inflamación, el ecocardiograma debe repetirse, al menos, semanalmente para evaluar si hay progresión de las complicaciones mencionadas. 12 La evaluación ecocardiográfica de las arterias coronarias debe ser lo más completa posible e incluir la CI, la DA, la CX, la CD, segmentos proximal, medio y distal, y la DP.…”

Section: Ecocardiogramaunclassified

Enfermedad de Kawasaki: Consenso interdisciplinario e intersociedades

2016

Arch Argent Pediat

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Coronary Artery Dimensions in Febrile Children Without Kawasaki Disease

Cited by 81 publications

References 17 publications

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

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

On What Day of Illness Does the Dilatation of Coronary Arteries in Patients With Kawasaki Disease Begin?

Enfermedad de Kawasaki: Consenso interdisciplinario e intersociedades

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