JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease

Fukazawa, Ryuji; Kobayashi, Junjiro; Ayusawa, Mamoru; Hamada, Hiromichi; Miura, Masaru; Mitani, Yoshihide; Tsuda, Etsuko; Nakajima, Hiroyuki; Matsuura, Hiroyuki; Ikeda, Kazuyuki; Nishigaki, Kazuhiko; Suzuki, Hiroyuki; Takahashi, Kei; Suda, Kenji; Kono, Hiroshi; Onouchi, Yoshihiro; Kobayashi, Toshimitsu; Yokoi, Hiroyoshi; Sakamoto, Kisaburo; Ochi, Masami; Kitamura, Soichiro; Hamaoka, Kenji; Senzaki, Hideaki; Kimura, Takeshi

doi:10.1253/circj.cj-19-1094

Cited by 225 publications

(278 citation statements)

References 360 publications

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“…Nevertheless, these values are higher than those in other studies where the prevalence of CAAs were found to vary from 3.6 to 17.4% 7,[13][14][15] . Data from a Korean national survey on KD, showed differences in the prevalence of CAAs using AHA criteria (21-42%) and a Japanese guideline (18%) for the same sample population 16 .…”

Section: Discussioncontrasting

confidence: 76%

“…Without treatment, patients may develop complications such as coronary artery aneurysms (CAAs), occurring as frequently as 15% to 25%. 2,3 Initiating a treatment with intravenous immunoglobulin (IVIG) within 10 days of onset leads to a reduced incidence of CAAs (to 4-10%) [1][2][3][4][5][6][7] . Persistent CAAs subsequently lead to thrombosis and stenotic lesions that result in myocardial ischemia and infarction [3].…”

Section: Introductionmentioning

confidence: 99%

“…Persistent CAAs subsequently lead to thrombosis and stenotic lesions that result in myocardial ischemia and infarction [3]. Aggressive management, such as thromboprophylaxis and revascularization intervention is sometimes required for patients with these complications 1,6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

Santimahakullert

Vijarnsorn

Wongswadiwat

et al. 2021

Preprint

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Kawasaki disease (KD) is a common vasculitis in children, which may be complicated with coronary artery aneurysms (CAAs). We aimed to report the rates of major adverse cardiac events (MACE) and determine the risks of MACE in children diagnosed with KD and CAAs in Thailand. Data of 170 children diagnosed with KD and CAAs in two centers of Thailand between 1994 and 2019 was retrospectively reviewed. The risks of MACE were analyzed using multivariate analysis. Of 170 patients, forty-nine patients (28.8%) had giant CAAs. During the median time of follow-up (5.4 years; ranging from 22 days to 23 years), 19 patients (11.1%) experienced MACE including 12 coronary artery bypass grafting, 2 percutaneous coronary intervention and 5 patients with evidence of coronary occlusion. Coronary interventions were performed at 4 years (ranging from 0.01 to 9.5 years) after the KD diagnosis. Independent risks of MACE in KD with CAAs were from the presence of giant aneurysms (HR 16.55; 95% CI 2.52 to 108.63; p=0.003) and lack of intravenous immunoglobulin (IVIG) treatment (HR 11.43; 95% CI 2.8 to 46.62; p=0.001). The intervention-free rate at 5 and 10 years in patients with giant CAAs was 78.7% and 52.2%, respectively.Trial registration: TCTR20190125004

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Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

Santimahakullert

Vijarnsorn

Wongswadiwat

et al. 2021

Preprint

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“…1). KD was diagnosed based on the criteria (Japanese, fifth edition) mentioned in the diagnostic guidelines for KD until August 2019 and on the revised criteria (Japanese, sixth edition) from September 2019 [9,10]. A total of 14 patients with complications before initial therapy or with follow-up periods of < 2 months were excluded (Fig.…”

Section: Participants and Methodsmentioning

confidence: 99%

Current Real-World Outcomes of Recurrent Kawasaki Disease

Nakada¹

2020

SJMH

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Studies have shown that recurrent Kawasaki disease (KD) is a risk factor for resistance to initial intravenous immunoglobulin (IVIG) therapy and development of coronary artery lesions (CALs). However, current real-world outcomes of recurrent KD patients remain unclear. The objective of this retrospective study was to elucidate the outcomes of recurrent KD patients in the era of 2 g/kg IVIG therapy. Data were included from 201 KD patients who underwent acute-phase treatment from January 2009 to September 2020, with 184 (91.5%) receiving 2 g/kg IVIG therapy. The patients were divided into 7 with (recurrent group) and 194 without (nonrecurrent group) recurrent KD. At the first onset, the rates of initial IVIG therapy resistance (28.6% vs. 21.5%, P = 1.000), rescue therapy (14.3% vs. 14.4%, P = 1.000), and CALs (0.0% vs. 2.6%, P = 1.000) were similar between the recurrent and nonrecurrent groups. The rates of initial IVIG therapy resistance (14.3% vs. 21.5%, P = 1.000), rescue therapy (14.3% vs. 14.4%, P = 1.000), and CALs (0.0% vs. 2.6%, P = 1.000) were also similar between the recurrent group at the second onset and the nonrecurrent group at the first onset. KD recurrence may no longer be a risk factor for developing CALs in the era of 2 g/kg IVIG therapy, unless CALs appear at the initial episode.

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“…The prevalence among 100,000 children aged 0-4 years was 319.6 in Japan, 170. 9-194.9 in Korea, 71.9-110.0 in China, 49.4 in Hawaii, and 18.1-21.3 in the USA (18). The incidence was highest among Asian children, especially of Japanese ancestry.…”

Section: Epidemiology Of Kdmentioning

confidence: 95%

An Update on Cardiovascular Risk Factors After Kawasaki Disease

Zeng

Zhang

et al. 2021

Front. Cardiovasc. Med.

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First described in Japan 50 years ago, Kawasaki disease is a worldwide multisystem disease. It is an acute self-limited vasculitis of unknown etiology that can lead to coronary artery lesions, such as dilatation, aneurysms, and stenosis in children. It is one of the common causes of acquired heart disease among children in developed countries. The coronary aneurysm is a severe complication in the acute stage, possibly leading to stenotic lesions or myocardial ischemia. More concerns have centered on endothelial damage and the early onset of atherosclerosis in patients with KD. Although the coronary artery aneurysm is small or degenerated, the vascular structure does not return to normal, vascular endothelial dysfunction and remodeling continue. Most patients diagnosed with coronary artery sequelae are at risk of long-term complications. There are still many unknown aspects regarding the long-term prognosis of patients. Concerns have centered on the early onset of atherosclerosis in patients with KD. There is still no consensus on the relationship between Kawasaki disease and atherosclerosis. This study aimed to evaluate if patients with a history of KD were at risk of accelerated atherosclerosis.

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JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease

Cited by 225 publications

References 360 publications

Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

Cardiac Events in Kawasaki Disease With Coronary Aneurysms Revisited, A Two-center Retrospective Cohort Study in Thailand

Current Real-World Outcomes of Recurrent Kawasaki Disease

An Update on Cardiovascular Risk Factors After Kawasaki Disease

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