Usefulness of Calcium Scoring as a Screening Examination in Patients With a History of Kawasaki Disease

Kahn, Andrew; Budoff, Matthew J.; Daniels, Lori B.; Oyamada, Jun; Gordon, John B.; Burns, Jane C.

doi:10.1016/j.amjcard.2016.11.055

Cited by 26 publications

(13 citation statements)

References 12 publications

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“…Coronary CT angiography is a sensitive noninvasive test to evaluate older patients for Kawasaki disease-associated coronary abnormalities (Fig 14). Interestingly, low-attenuation lesions that mimic noncalcified atherosclerotic plaque may also be observed (53). The coarse calcifications often described within the coronary arteries of patients with Kawasaki disease is a later finding, usually evident years after the acute phase and rarely seen without underlying CAAs (53) (Fig 15).…”

Section: Vasculitis Kawasaki Diseasementioning

confidence: 99%

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

Jeudy¹,

White²,

Kligerman³

et al. 2018

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Advances in medical diagnosis reveal that coronary artery aneurysms (CAAs) may develop in several clinical scenarios and manifest variable symptoms, imaging appearances, and outcomes. Aneurysms are pathologically classified into three groups: atherosclerotic, inflammatory, and noninflammatory. The last category is associated with congenital, inherited, and connective tissue disorders. Overlap exists among the groups, because secondary atherosclerotic change may be present in an aneurysm of any cause. Atherosclerosis is the most common cause of CAAs in adults, and inflammation is considered the underlying mechanism. In children, Kawasaki disease is the most likely cause of CAAs. In both conditions, the aneurysms are usually multiple and affect more than one coronary artery. Mycotic (infectious), iatrogenic, and cocaine-induced CAAs are also well documented. Most CAAs are discovered incidentally, but potential cardiovascular complications include thrombosis, occlusion, fistula formation, rupture, myocardial infarction, and cardiac tamponade. Imaging modalities to evaluate a suspected CAA include transthoracic echocardiography, angiographic cardiac catheterization, electrocardiographically gated computed tomographic angiography, cardiac magnetic resonance (MR) imaging, and MR angiography. Management is usually individualized, and options include surveillance, anticoagulant therapy, percutaneous stent or coil placement, surgical resection, and coronary artery bypass grafting.

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Section: Vasculitis Kawasaki Diseasementioning

confidence: 99%

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

Jeudy¹,

White²,

Kligerman³

et al. 2018

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“…Blood calcium changes in KD patients have not been discussed frequently before. Andrew M. Kahn and his colleagues reported that coronary artery calcium scoring had a good performance in detecting coronary artery abnormalities in KD patients [ 33 ], but the relationship between coronary artery calcium scoring and blood calcium is still uncertain [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

A machine learning approach to predict intravenous immunoglobulin resistance in Kawasaki disease patients: A study based on a Southeast China population

Wang¹,

Liu²,

Lin

2020

PLoS ONE

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Kawasaki disease is the leading cause of pediatric acquired heart disease. Coronary artery abnormalities are the main complication of Kawasaki disease. Kawasaki disease patients with intravenous immunoglobulin resistance are at a greater risk of developing coronary artery abnormalities. Several scoring models have been established to predict resistance to intravenous immunoglobulin, but clinicians usually do not apply those models in patients because of their poor performance. To find a better model, we retrospectively collected data including 753 observations and 82 variables. A total of 644 observations were included in the analysis, and 124 of the patients observed were intravenous immunoglobulin resistant (19.25%). We considered 7 different linear and nonlinear machine learning algorithms, including logistic regression (L1 and L1 regularized), decision tree, random forest, Ada-Boost, gradient boosting machine (GBM), and lightGBM, to predict the class of intravenous immunoglobulin resistance (binary classification). Data from patients who were discharged before Sep 2018 were included in the training set (n = 497), while all the data collected after 9/1/2018 were included in the test set (n = 147). We used the area under the ROC curve, accuracy, sensitivity, and specificity to evaluate the performances of each model. The gradient GBM had the best performance (area under the ROC curve 0.7423, accuracy 0.8844, sensitivity 0.3043, specificity 0.9919). Additionally, the feature importance was evaluated with SHapley Additive exPlanation (SHAP) values, and the clinical utility was assessed with decision curve analysis. We also compared our model with the Kobayashi score, Egami score, Formosa score and Kawamura score. Our machine learning model outperformed all of the aforementioned four scoring models. Our study demonstrates a novel and robust machine learning method to predict intravenous immunoglobulin resistance in Kawasaki disease patients. We believe this approach could be implemented in an electronic health record system as a form of clinical decision support in the near future.

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“…Coronary artery calcium scoring may be a useful tool to screen patients with a remote history of Kawasaki disease or unknown coronary artery status such as probable Kawasaki disease. 9 We reported that the larger coronary artery diameter caused by Kawasaki disease, resulted in an earlier appearance of coronary artery calcifications in the coronary artery lesions. 10 The timing of the appearance of coronary artery calcifications between the giant aneurysms and medium aneurysms differed.…”

Section: Discussionmentioning

confidence: 94%

Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms

et al. 2020

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Over a 50-year period from the first description of Kawasaki disease, we encountered three male patients with a history of Kawasaki disease, who had their first cardiac events in their forties. They were considered to have almost normal coronary arteries in the coronary angiograms when they were children and adolescents. They had no follow-up examinations after 20 years old. The 1st patient had an acute myocardial infarction, and the 2nd was a new appearance of coronary aneurysm and stenotic lesions with coronary artery calcification. The 3rd patient had unexpected sudden death. The interval from the onset of Kawasaki disease to the cardiac events ranged from 37 to 38 years. In the former two patients, coronary artery lesions could not be evaluated immediately after Kawasaki disease. Although the 3rd patient had bilateral medium-sized coronary artery aneurysms, his coronary aneurysms regressed 1 year after acute Kawasaki disease. The intimal thickening at a previous coronary aneurysm at the age of 19 was mild. The patients with regressed coronary aneurysms were asymptomatic for about 40 years after Kawasaki disease, prior to their cardiac events. Coronary artery calcification of the proximal portion of the major coronary arteries was a predictable marker in such patients. To prevent serious cardiac events in middle-aged adult patients, reevaluation of coronary artery lesions and restarting of anti-thrombotic therapy are needed. We must be aware that there are some differences in the clinical course and time of cardiac events between patients with giant aneurysms and those with medium aneurysms.

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Usefulness of Calcium Scoring as a Screening Examination in Patients With a History of Kawasaki Disease

Cited by 26 publications

References 12 publications

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

Spectrum of Coronary Artery Aneurysms:From the Radiologic Pathology Archives

A machine learning approach to predict intravenous immunoglobulin resistance in Kawasaki disease patients: A study based on a Southeast China population

Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms

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