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

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

doi:10.1161/circimaging.112.976969

Cited by 41 publications

(25 citation statements)

References 51 publications

(67 reference statements)

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“…CMRI of 60 patients at an average interval of 11.6 years after acute KD did not demonstrate differences in right ventricular or LV sizes or function compared with control subjects. 153 Delayed gadolinium enhancement, in a pattern consistent with MI, was identified in only 2 patients with persistent giant coronary artery aneurysms. Quantitative myocardial perfusion with CMRI identified abnormal perfusion reserve in KD convalescent patients that was independent of coronary artery status.…”

Section: Noninvasive Modalitiesmentioning

confidence: 96%

“…Transesophageal echocardiography, CTA, and CMRI can be useful for the evaluation of older children and adolescents in whom visualization of the coronary arteries with transthoracic echocardiography is inadequate. 153,154 Evaluation of potential aneurysmal involvement in other arterial beds can be assessed with CMRI, CTA, and, rarely, invasive angiography, but such assessment is best performed after recovery from the acute illness, and usually for patients with severe coronary artery involvement or symptoms or signs, such as the presence of a pulsatile axillary mass. 155,156 Recommendations for Cardiovascular Assessment for Diagnosis and Monitoring During the Acute Illness …”

Section: Other Cardiovascular Imaging Modalitiesmentioning

confidence: 99%

“…Clinical experience indicates that myocardial function is normal, except among patients with ischemic heart disease from coronary artery stenoses. 153,236 Arrhythmias Generally, the development of important rhythm changes in KD has been documented primarily in those patients manifesting more severe forms of myocardial dysfunction, including those patients with overt myocardial ischemia or infarction. Premature ventricular contractions and ventricular tachycardia have been taken as clinical markers of underlying myocardial damage and as potential predictors of long-term consequences, including late sudden death.…”

Section: Myocardial 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

2,863

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: Noninvasive Modalitiesmentioning

confidence: 96%

Section: Other Cardiovascular Imaging Modalitiesmentioning

confidence: 99%

Section: Myocardial Abnormalitiesmentioning

confidence: 99%

See 1 more Smart Citation

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

2,863

4,124

View full text Add to dashboard Cite

show abstract

“…Our data suggest that plasma levels of Gal-3 may be a biomarker for myocardial and vascular fibrosis that occurs in a subset of convalescent KD patients with giant aneurysms. There is currently no accepted method to detect myocardial fibrosis after KD ante-mortem although research groups are testing late gadolinium contrast enhancement by magnetic resonance imaging [18]. A reliable biomarker for fibrosis would allow assessment of potential therapeutic interventions to prevent progression of fibrous scar in the myocardium and arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…However, in a KD patients who initially had left ventricular dysfunction during the acute phase by echocardiography, only 2/60 (3.3%) had abnormalities of the myocardium seen by CMRI late gadolinium contrast enhancement (CMRI-LGE) during the late convalescent phase [18]. Thus, using currently available techniques, CMRI-LGE may miss diffuse fibrosis and a biomarker for these histologic changes is needed.…”

Section: Discussionmentioning

confidence: 99%