Novel and traditional cardiovascular risk factors in children after Kawasaki disease

Cheung, Yiu‐fai; Yung, TC; Tam, Sidney; Ho, Marco H. K.; Chau, Anson C.M.

doi:10.1016/j.jacc.2003.08.030

Cited by 141 publications

(129 citation statements)

References 29 publications

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“…Therefore, we cannot exclude the possibility that the present sample sizes were not sufficient to allow detection of differences in characteristic impedance and C/BSA between the 2 KD groups. Although several previous hemodynamic and histopathologic studies 32,35,44 suggested that arterial stiffness increases regardless of coronary artery involvement, which is consistent with the present results (no difference in characteristic impedance or C/BSA between groups 1A and 1B), further studies clearly are needed to confirm the present findings.…”

Section: Study Limitationssupporting

confidence: 92%

“…Noto et al 31 showed increased carotid arterial stiffness in 20 KD patients with CAL using a stiffness index based on ultrasonographic measurements. Cheung et al 32 observed increased pulse-wave velocity (a measure of arterial stiffness) in the brachioradial artery of KD patients with and without CAL. The present data demonstrate several novel aspects of systemic arterial stiffening after KD.…”

Section: Arterial Stiffening After Kdmentioning

confidence: 99%

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Arterial Hemodynamics in Patients After Kawasaki Disease

et al. 2005

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Background-Histopathological findings in the acute stage of Kawasaki disease (KD) indicate widespread vascular inflammation that involves not only coronary arteries but also systemic arteries. This may cause changes in systemic arterial wall properties after KD, which could have adverse effects on arterial hemodynamics (an important predictor of cardiovascular morbidity and mortality). Methods and Results-Systemic arterial hemodynamics were investigated by measuring aortic input impedance during cardiac catheterization in 42 KD patients who had developed coronary artery lesions (CALs) in the acute stage of KD. The KD patients were subdivided into 2 groups according to the angiographic findings (group 1A, 26 patients with persistent CALs; group 1B, 16 patients with regressed CALs), and results were compared with those of 36 referents (group 2). Compared with referents, characteristic impedance was significantly higher for KD patients (137.0Ϯ5.1, 125.7Ϯ8.2, and 97.9Ϯ4.1 dyne · s · cm Ϫ5 · m 2 for group 1A, group 1B, and group 2, respectively), and total peripheral arterial compliance indexed to age-specific values was significantly lower for KD patients (group 1A 72.9Ϯ4.2% of normal; group 1B 70.6Ϯ5.9% of normal; group 2 97.7Ϯ4.0% of normal; for both variables, PϽ0.05 for each KD group versus group 2; PϭNS between KD groups), which suggests that both central and peripheral arterial wall stiffness increase after KD regardless of persistence of CALs. Also, indices of arterial wave reflection (reflection coefficient, reflection factor, and augmentation index) were all significantly higher in KD patients than in referents (PϽ0.05), with the result that the aortic pressure waveforms of the present KD patients resembled those generally observed in the elderly. In addition, levels of circulating markers of endothelial dysfunction (ACE and von Willebrand factor) were associated with increased vascular stiffening in KD patients but not in referents. Conclusions-These results indicating abnormal arterial hemodynamics after KD highlight the importance of regular monitoring of the systemic arterial bed and potentially relevant cardiovascular events in long-term follow-up of KD.

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Section: Study Limitationssupporting

confidence: 92%

Section: Arterial Stiffening After Kdmentioning

confidence: 99%

Arterial Hemodynamics in Patients After Kawasaki Disease

et al. 2005

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“…227 In addition, Kawasaki disease produces altered lipid metabolism that persists beyond clinical resolution of the disease. 75,77,228 Children with Kawasaki disease with normal coronary arteries also have been reported to have higher brachial-radial artery mean pulse wave velocity than do children without Kawasaki disease, suggesting increased arterial stiffness. 228 Histological data concerning the longterm status of the coronary arteries in children who never had demonstrable abnormalities are few and difficult to interpret.…”

Section: Course After Kawasaki Disease Without Detectable Coronary Lementioning

confidence: 99%

“…75,77,228 Children with Kawasaki disease with normal coronary arteries also have been reported to have higher brachial-radial artery mean pulse wave velocity than do children without Kawasaki disease, suggesting increased arterial stiffness. 228 Histological data concerning the longterm status of the coronary arteries in children who never had demonstrable abnormalities are few and difficult to interpret. 223,229 Some investigators in Japan have studied coronary physiology in the population without aneurysms.…”

Section: Course After Kawasaki Disease Without Detectable Coronary Lementioning

confidence: 99%

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

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,614

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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“…In Familial Mediterranean Fever [12], and even after resolved vasculitis in Kawasaki's disease, elevated baPWV is present [18]. Andoh et al [19] found a correlation between baPWV and high sensitivity C-reactive protein (hs-CRP) in Japanese men.…”

Section: Mechanistic Links Of Pwv To Acute and Chronic Diseasementioning

confidence: 99%

Taking the pulse of a sick kidney: Arterial stiffness in glomerulonephritis

Doyon

Schaefer

2010

Pediatr Nephrol

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Arterial stiffness is an increasingly recognized independent predictor of cardiovascular morbidity. Vessel volume and wall texture are the main determinants of pulse wave velocity (PWV), the most commonly used indicator of arterial elasticity. Hence, measurements of PWV will be affected by the site of measurement and the overall dimensions of the vascular tree as well as by alterations of vascular morphology. In children, methodological heterogeneity and the lack of pediatric reference values complicate the interpretation of PWV. Arterial elasticity is altered in numerous clinical conditions such as vasculitis, end-stage renal disease, and diabetes. Novel evidence suggests that acute postinfectious glomerulonephritis, but not pyelonephritis, is also associated with increased arterial stiffness, the persistence of which may predict the emergence of chronic kidney disease. We review the potential mechanisms underlying the link between acute and chronic kidney disease and impaired arterial elasticity. These might include activation of the renin-angiotensin system, sympathetic hyperactivation, and a subclinical state of inflammation. In view of the excessive cardiovascular comorbidity associated with kidney disease, the increasing evidence of the prognostic relevance of arterial stiffness should encourage further research investigating the usefulness of PWV as a biomarker in acute and chronic kidney disorders.

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Novel and traditional cardiovascular risk factors in children after Kawasaki disease

Abstract: An adverse cardiovascular risk profile, as characterized by a proatherogenic alteration of the lipid profile and increased arterial stiffness, occurs in children after KD. The profile is worse in those with than in those without coronary aneurysms.

Cited by 141 publications

References 29 publications

Arterial Hemodynamics in Patients After Kawasaki Disease

Arterial Hemodynamics in Patients After Kawasaki Disease

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

Taking the pulse of a sick kidney: Arterial stiffness in glomerulonephritis

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