Long-term echocardiographic evaluation of cardiac size and function in patients with Kawasaki disease

Anderson, Tracy; Meyer, Richard A.; Kaplan, Samuel

doi:10.1016/0002-8703(85)90523-x

Cited by 52 publications

(28 citation statements)

References 26 publications

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“…[130][131][132] The severity of myocarditis does not appear to be associated with the risk of coronary artery aneurysms, however. 133,134 Although the majority of patients with Kawasaki disease has abnormal myocardial contractility by echocardiographic assessment at presentation, myocardial mechanics improve rapidly after IVIG therapy, with a high concordance between the clinical and myocardial responses to therapy. 135 The speed of recovery suggests that depressed contractility in patients with Kawasaki disease is caused by rapidly reversible mechanisms such as those involving circulating toxins or activated cytokines.…”

Section: Myocarditismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Pediatrics

1,697

2,533

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ABSTRACT. Background. Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ϳ15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.Methods and Results. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for >5 days and <4 classic criteria should undergo electrocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-␣ antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.Conclusions. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients. Pediatrics

show abstract

Section: Myocarditismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Pediatrics

1,697

2,533

View full text Add to dashboard Cite

show abstract

“…130 -132 The severity of myocarditis does not appear to be associated with the risk of coronary artery aneurysms, however. 133,134 Although the majority of patients with Kawasaki disease has abnormal myocardial contractility by echocardiographic assessment at presentation, myocardial mechanics improve rapidly after IVIG therapy, with a high concordance between the clinical and myocardial responses to therapy. 135 The speed of recovery suggests that depressed contractility in patients with Kawasaki disease is caused by rapidly reversible mechanisms such as those involving circulating toxins or activated cytokines.…”

Section: Myocarditismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,613

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…[4][5][6][7] In the past, myocardial inflammation has been documented in up to 50% to 70% of patients early in the KD course with the use of different diagnostic methods. [8][9][10] This finding has been supported by autopsy and biopsy studies showing that almost all patients had some signs of myocarditis, pericarditis, or valvulitis.…”

mentioning

confidence: 99%

“…12 Consistent with the pathological findings, echocardiographic long-term abnormalities of LV size and function were reported. 4 Subsequent echocardiographic studies have reported normalization of myocardial function during reconvalescence, most likely because of IVIG treatment. 5,7 Although LV dysfunction is a well-known feature of the acute phase, investigations of the long-term effects on cardiac function are limited and have produced conflicting results.…”

mentioning

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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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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Long-term echocardiographic evaluation of cardiac size and function in patients with Kawasaki disease

Cited by 52 publications

References 26 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

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

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