On What Day of Illness Does the Dilatation of Coronary Arteries in Patients With Kawasaki Disease Begin?

Fuse, Shigeto; Mori, Toshihiko; Kuroiwa, Yuki; Hirakawa, Satoshi

doi:10.1253/circj.cj-17-0046

Cited by 11 publications

(15 citation statements)

References 18 publications

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“…Therefore, the Z-score may be useful for direct and sensitive detection of early coronary artery dilatation compared with clinical ndings, such as fever and serum CRP concentration. Fuse et al reported that 23.4% of patients showed coronary artery dilatation (Z-score ≥2.0) after 5 days of illness during the pre-treatment phase [25], which is consistent with our ndings (67/281, 23.8%).…”

Section: Discussionsupporting

confidence: 93%

“…Patients with Kawasaki disease in Japan tend to start treatment earlier compared with patients in other studies. Fuse et al reported that 42.9% of patients showed coronary artery dilatation (Z-score ≥2.0) after 7 days of illness during the pretreatment phase, but only 11% of patients showed coronary artery dilatation (Z-score ≥2.0) after 4 days of illness according to the cumulative probability curve [25]. Thus, it may not be appropriate to predict CALs at a P1-Zmax ≥2.0 in cases where treatment is started earlier.…”

Section: Discussionmentioning

confidence: 99%

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Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

et al. 2021

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Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age <12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circum ex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥2.5 represented CAL development. Clinical parameters, such as laboratory data and Zscores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax − P1-Zmax) ≥1, male sex, <12 months of age, and resistant to the rst IVIG administration (adjusted odds ratio [95% con dence interval]: 1.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

et al. 2021

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“…The present study had some limitations. First, the echocardiographic results during the subacute and the convalescent stage were not collected and analyzed, because most of the CALs occurred during the early stage of the disease (25). However, it should be further investigated to give an overview.…”

Section: Discussionmentioning

confidence: 99%

Neutropenia Is Not Associated With the Outcomes in Patients With Kawasaki Disease

et al. 2021

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Objective: To investigate the outcomes of coronary artery lesions (CALs) and intravenous immunoglobulin (IVIG) resistance in patients with and without neutropenia during the disease course and to explore the relationships between Δ absolute neutrophils count (ΔANC) and the outcomes.Methods: We retrospectively reviewed the medical records of patients hospitalized in Children's Hospital of Soochow University with a main diagnosis of KD during January 2019 and December 2019. 1:4 propensity score matching was carried out to adjust the baseline characteristics. Smoothed plots and threshold effect analyses were performed to reveal the relationships between ΔANC and the outcomes.Results: Of the 438 patients enrolled, 75 (17.1%) were neutropenia cases and 363 (82.9%) were non-neutropenia cases. Patients with neutropenia were younger, had lower levels of initial ANC, white blood cell (WBC) count and C-reactive protein (CRP). Propensity score matching included 75 neutropenia and 247 non-neutropenia patients. No significant difference was found between neutropenia and non-neutropenia groups regarding CALs, coronary artery aneurysms, irregular coronary lumen, IVIG resistance and days of fever duration. There was a non-linear relationship between ΔANC and IVIG resistance. However, threshold effect analysis showed the incidence of IVIG resistance decreased with increasing ΔANC before the turning point (ΔANC = 1.6) (OR = 0.65, 95% CI = 0.50–0.8.4 P = 0.001). On the other hand, there was a linear relationship between ΔANC and CALs, even after adjusting the confounders (OR = 1.06, 95% CI = 1.02–1.11, P = 0.008).Conclusions: Neutropenia after IVIG was not exactly associated with the outcomes. However, ΔANC was in relation to CALs and IVIG resistance.

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“…Recently, Fuse et al demonstrated that changes in coronary artery Z-scores may be observed in the early phase of KD already. Coronary artery dilation occurred within the first 10 days of illness in 70% of the KD patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Value of serial echocardiography in diagnosing Kawasaki’s disease

et al. 2020

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Kawasaki disease (KD) is an acute vasculitis predominantly affecting the small arteries of young children. Up to 25% of untreated patients suffer from coronary artery (CA) complications. Early diagnosis and treatment is mandatory in incomplete KD to reduce the risk of coronary involvement. Between 2002 and 2018, 124 patients have been diagnosed suffering from KD at the University Children’s Hospital Regensburg (KUNO). We assessed luminal diameters of both CAs normalized as Z-scores by 2D-echocardiography. A total of 94 patients were analyzed. Of them, 31 (33%) were affected by an incomplete form of KD. In 24 children (26%), serial echocardiography was necessary in order to confirm diagnosis. Mean Z-scores for the left main coronary artery (LMCA), right main coronary artery (RMCA), and left anterior descending artery increased significantly between the initial (LMCA 0.79z, RMCA 0.15z, LAD 0.49z) and second (LMCA 1.69z, RMCA 0.99z, LAD 1.69z) examination (p < 0.05). Conclusion:To confirm diagnosis of KD, it might not be necessary to detect dilation or aneurysms. Our observation suggests that patients suspected having KD should be monitored with serial echocardiography in order to detect a possible enlargement of the CA diameters, even if Z-scores are within the normal range. What is Known:• Kawasaki disease (KD) is an acute vasculitis predominantly affecting the small arteries of young children. Up to 25% of untreated patients suffer from coronary artery (CA) complications.• Due to less classic clinical criteria in patients with incomplete KD, the risk for CA pathology is even higher. What is New:• A significant progression of patients’ CA Z-scores in serial echocardiographic measurements may be helpful to ensure diagnosis of KD early even if Z-scores are within the normal range.• Twenty-seven patients (90%) with incomplete KD could be diagnosed within 10 days of fever, early enough to prevent significantly higher rates of CA aneurysm.

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On What Day of Illness Does the Dilatation of Coronary Arteries in Patients With Kawasaki Disease Begin?

Cited by 11 publications

References 18 publications

Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

Neutropenia Is Not Associated With the Outcomes in Patients With Kawasaki Disease

Value of serial echocardiography in diagnosing Kawasaki’s disease

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