Pathology of Kawasaki Disease: I. Pathology and Morpphogenesis of the Vascular Changes

Amano, Shigeru; Hazama, Fumitada; Hamashima, Yoshihiro

doi:10.1253/jcj.43.633

Cited by 149 publications

(94 citation statements)

References 8 publications

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“…In the subsequent reparative process, elastic tissue is replaced by fibrous scar tissue, and intimal thickening and proliferation of medial smooth muscle cells are sometimes observed in the convalescent stage. 6,7,33 Importantly, similar histopathologic changes have been observed in systemic arteries ranging from large elastic and musculoelastic arteries to small intravisceral arteries. 7,8,34 Furthermore, intimal thickening with fibrous scar formation and smooth muscle proliferation have been observed in systemic arteries of children who have had KD, even years after resolution of acute illness.…”

Section: Implications Of Changes In Arterial Hemodynamics After Kdmentioning

confidence: 60%

“…28 Histopathologic studies have demonstrated destruction of the coronary arterial wall during the acute phase of KD. 6,7,33 Infiltration by inflammatory cells begins in the intima with degradation of endothelial cells and disruption of the elastic lamina. These changes then spread to the media and adventitia.…”

Section: Implications Of Changes In Arterial Hemodynamics After Kdmentioning

confidence: 99%

“…[2][3][4] Because morbidity and mortality late after resolution of acute KD appear to be associated primarily with coronary artery lesions (CALs), 4,5 attention has been focused on the longterm outcome of CALs after acute KD; however, histopathologic findings in the acute stage of KD indicate widespread vascular inflammation with endothelial and medial degeneration and subsequent fibrous scar formation that involve systemic and coronary arteries. 6,7 Furthermore, such abnormalities in the systemic vascular bed may persist for years after acute KD, 6 -8 possibly causing lasting changes in arterial hemodynamics, which are an important predictor of cardiovascular morbidity and mortality. 9 -11 Aortic input impedance integrates functional and structural changes in systemic vascular properties, providing comprehensive information about the state of the vascular bed that includes both frequency-independent static (resistance) and frequency-dependent dynamic (stiffness and wave reflection) components.…”

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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: Implications Of Changes In Arterial Hemodynamics After Kdmentioning

confidence: 60%

Section: Implications Of Changes In Arterial Hemodynamics After Kdmentioning

confidence: 99%

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Arterial Hemodynamics in Patients After Kawasaki Disease

et al. 2005

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“…KD is a multisystem inflammatory illness that predominately affects children 6 months to 5 years of age, although younger infants and older children can also develop the illness (Amano et al, 1979). KD can result in acute vasculitis, most strikingly of the coronary arteries (Newburger et al, 1986).…”

Section: Kawasaki Disease (Kd)mentioning

confidence: 99%

“…Histopathological findings have indicated destruction of coronary artery walls with diffuse vasculitis, raising the possibility that MMPs are also involved in coronary arterial wall destruction and the formation of CAAs (Amano et al, 1979). Among patients with KD, those with coronary artery lesions have higher plasma levels of both MMP 3 and MMP 9.…”

Section: Kawasaki Disease (Kd)mentioning

confidence: 99%