High Risk of Coronary Artery Aneurysms in Infants Younger than 6 Months of Age with Kawasaki Disease

Salgado, Andrea; Ashouri, Negar; Berry, Erika; Sun, Xiaoying; Jain, Sonia; Burns, Jane C.; Tremoulet, Adriana H.

doi:10.1016/j.jpeds.2017.03.025

Cited by 128 publications

(97 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings may not apply to infants with KD younger than 6 months, who may have clinically significant variability in z scores with even small differences in absolute measurements and who are at higher risk for adverse CA outcomes. 14 Finally, our study findings should not be used to eliminate echocardiograms in children whose initial CA dimensions are abnormal; these children often require even greater frequency of coronary imaging. 5…”

Section: Limitationsmentioning

confidence: 94%

Association of Initially Normal Coronary Arteries With Normal Findings on Follow-up Echocardiography in Patients With Kawasaki Disease

et al. 2018

Self Cite

View full text Add to dashboard Cite

guidelines recommend echocardiography in Kawasaki disease at baseline, 1 to 2 weeks, and 4 to 6 weeks after treatment to detect coronary artery abnormalities. However, these examinations are expensive and may require sedation in young children, which is burdensome and carries some risk. OBJECTIVE To assess the benefit of additional echocardiographic imaging at 6 weeks in patients with uncomplicated Kawasaki disease who had previously normal coronary arteries. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of patients with Kawasaki disease who were cared for between 1995 and 2014 in 2 academic pediatric referral practices Eligibility criteria included receiving intravenous immunoglobulin treatment for acute Kawasaki disease at a center; the absence of significant congenital heart disease; available echocardiographic measurements of both the right and left anterior descending coronary arteries at 10 days or less after diagnosis (baseline), 2 (±1) weeks, and 6 (±3) weeks of illness; and normal coronary arteries at baseline and 2 weeks, defined as maximum coronary artery z scores less than 2.0 and no distal aneurysms. Data analysis was completed from March 2015 to November 2015. MAIN OUTCOMES AND MEASURES The number of patients with right coronary artery or left anterior descending coronary artery z scores of 2.0 or more at 6 weeks. RESULTS The median age of the 464 included patients was 3.3 years (interquartile range, 1.8-5.4 years); 264 (56.9%) were male, 351 of 414 for whom data were available (84.8%) had complete Kawasaki disease, and 66 (14.2%) received additional intravenous immunoglobulin treatment. At 6 weeks of illness, 456 patients (98.3%) who had had normal coronary artery z scores at baseline and 2 weeks continued to have normal z scores. Of the remaining 8 patients (1.7%), the maximum z score within 6 weeks was 2.0 to 2.4 in 5 patients (1.2%), 2.5 to 2.9 in 1 patient (0.2%), and 3.0 or more in 2 patients (0.4% [95% CI, 0.1%-1.5%]). Coronary artery dimensions ultimately normalized in all but 1 patient, who had minimal dilation at 6 weeks (right coronary artery z score, 2.1). Sensitivity analyses using less restrictive cut points (eg, a maximum z score <2.5) or less restrictive timing windows (eg, considering patients with incomplete echocardiographic data within 21 days) gave similar results; in these analyses, 454 to 463 of 464 patients (98% to 99.7%) had coronary artery z scores of less than 2.5 at 6 weeks. CONCLUSIONS AND RELEVANCE New abnormalities in coronary arteries are rarely detected at 6 weeks in patients with Kawasaki disease who have normal measurements at baseline and 2 weeks of illness, suggesting that the 6-week echocardiographic imaging may be unnecessary in patients with uncomplicated Kawasaki disease and z scores less than 2.0 in the first 2 weeks of illness.

show abstract

Section: Limitationsmentioning

confidence: 94%

Association of Initially Normal Coronary Arteries With Normal Findings on Follow-up Echocardiography in Patients With Kawasaki Disease

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…As children with incomplete KD often remain undiagnosed for several days, there are greater chances of development of coronary artery abnormalities (CAAs). 28 Infants with KD can also present with pyuria (as a result of the associated urethritis) and this may be erroneously thought to be due to a urinary tract infection. This can result in further delays in arriving at a diagnosis.…”

Section: Kd In Special Situations Kd In Infantsmentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

View full text Add to dashboard Cite

Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

show abstract

“…KD in this age group may often remain undiagnosed for several days, leading to increased incidence of development of CAAs. This group of patients also has higher intravenous immunoglobulin (IVIg) resistance [28,30,40,41]. Sterile pyuria is another clinical presentation of KD in this age group and may mistakenly get treated as a urinary tract infection.…”

Section: Kd In Infantsmentioning

confidence: 99%

Kawasaki Disease

Pilania¹,

Singh²

2019

Periodic and Non-Periodic Fevers

View full text Add to dashboard Cite

Kawasaki disease (KD) is an acute and usually self-limiting medium vessel vasculitis of childhood that has a predilection to involve the coronary arteries. It is characterized by the sequential appearance of a constellation of clinical features [1]. However, none of these clinical findings is, in itself, pathognomonic of KD. Many of these clinical features can, in fact, be seen in other common febrile illnesses of children. It is for this reason that the diagnosis of KD is often considered to be a clinical challenge [2]. Approximately 15-25% of untreated patients may go on develop coronary artery abnormalities (CAAs) and this remains the major cause of morbidity, and occasional mortality, in KD [3].

show abstract

High Risk of Coronary Artery Aneurysms in Infants Younger than 6 Months of Age with Kawasaki Disease

Cited by 128 publications

References 14 publications

Association of Initially Normal Coronary Arteries With Normal Findings on Follow-up Echocardiography in Patients With Kawasaki Disease

Association of Initially Normal Coronary Arteries With Normal Findings on Follow-up Echocardiography in Patients With Kawasaki Disease

Diagnosis of Kawasaki disease

Kawasaki Disease

Contact Info

Product

Resources

About