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Singhal M, Pilania RK, Gupta P, Johnson N, Singh S. Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease. World J Clin Pediatr 2023; 12:97-106. [PMID: 37342454 PMCID: PMC10278081 DOI: 10.5409/wjcp.v12.i3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Nameirakpam Johnson
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
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Wongbundit C, Vijarnsorn C, Pornprasertchai V, Somkittitham P, Bositthipichet D, Tongbunnum T, Chanthong P. Coronary changes and cardiac events in children diagnosed with kawasaki disease without initial coronary aneurysm : A multicenter retrospective cohort study. Front Pediatr 2023; 11:1121905. [PMID: 37009278 PMCID: PMC10050552 DOI: 10.3389/fped.2023.1121905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background Kawasaki disease (KD) is a systemic vasculitis affecting young children, which may lead to coronary artery aneurysm (CAA). The optimal timing of serial echocardiography in patients with uncomplicated KD is debated. Objectives To assess changes in coronary artery Z-scores from the initial diagnosis, two weeks, eight weeks, and one year following diagnosis and adverse cardiac events in children diagnosed with KD without initial CAA. Methods Retrospective chart reviews of four referral centers in Thailand were conducted of all children who were diagnosed with KD without initial CAA (coronary artery Z-score < 2.5) between 2017 and 2020. Eligibility criteria included the absence of congenital heart disease and patients with available echocardiographic evaluations at baseline and at eight weeks of illness. The two-week and one-year echocardiographies were reported. Adverse cardiac events at one year from diagnosis were explored. The primary outcome was a maximal coronary Z-score on the follow-up echocardiography at eight weeks and one year. Results Of 200 patients diagnosed with KD, 144 patients (72%) did not have CAA. A total of 110 patients were included in the study. The median age was 23 months (IQR, 2-39 months) and 60% were male. Fifty patients (45.5%) had incomplete KD, and four (3.6%) received a second intravenous immunoglobulin treatment. Of 110 patients, 26 patients (23.6%) had coronary ectasia (Z-score of 2-2.49) on their initial echocardiographic examination. Sixty-four patients were evaluated in two-week echocardiographic studies, which showed four new small CAAs and five coronary ectasia. At 8 weeks, 110 patients had undergone complete echocardiographic studies. No patient had residual CAAs. Only one patient had persistent coronary ectasia that regressed to normal within one year. At one-year follow-up (n = 90), no cardiac events were reported. Conclusion New CAA in-patients with KD who had no previous CAA in their initial echocardiography are rare. In addition, patients who had normal echocardiographic follow-up at two weeks or eight weeks mostly continued to be normal at one year. The optimal timing of the echocardiographic follow-up should be at two to eight weeks in patients without initial CAA, who still have a coronary artery Z-score < 2 at the second echocardiography.Trial registration: TCTR20210603001.
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Affiliation(s)
- Chanikarn Wongbundit
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Chodchanok Vijarnsorn
| | | | | | | | | | - Prakul Chanthong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Imaging Evaluation of Kawasaki Disease. Curr Cardiol Rep 2022; 24:1487-1494. [DOI: 10.1007/s11886-022-01768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/26/2022]
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Yokouchi Y, Oharaseki T, Asakawa N, Makino H, Takahashi K. Histological studies shed new light on the initiation and characteristics of calcification of coronary artery aneurysms in Kawasaki disease. Cardiovasc Pathol 2022; 61:107456. [PMID: 35868495 DOI: 10.1016/j.carpath.2022.107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Calcification of coronary artery aneurysms (CAAs) is common in the remote phase of Kawasaki disease (KD), but the detailed features of its development remain unclear. This study aimed to elucidate the histological characteristics of calcification in KD CAAs. MATERIALS AND METHODS The study materials consisted of 24 coronary artery branches with aneurysms that were obtained from 14 Japanese patients who died during the period from 40 days to 3 years after the onset of KD. We first examined the CAAs for the presence of thrombi and calcification. When calcifications were observed, we determined their location and shape, and investigated the time-course of the changes based on the time-interval from KD onset until death. Then we measured the area of each calcification and examined for correlations between the calcified area and (1) the disease duration and (2) the aneurysm diameter. RESULTS Calcification was observed in 14 of the 24 CAAs (in 7 of 13 LCA and 7 of 11 RCA). Thrombi were also seen in 13 of the 14 CAAs with calcification. Calcification showed two localizations: in the organized portion of the thrombus (seen in 12 CAAs) and deep in the thickened tunica of the intima (3 CAAs). The earliest observation of calcification was in an infant who died on the 49th disease day: it was a small, band-shaped calcified lesion in granulation tissue that had formed at the boundary between the thrombus and the blood vessel wall. As the duration of KD increased, the calcified lesion increased in size, and nodular shapes were formed. Moreover, the calcified area tended to increase as the diameter of the aneurysm increased. CONCLUSION Histologically, CAA calcification starts early in the remote phase of KD, and it is closely related to organization of thrombi.
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Affiliation(s)
- Yuki Yokouchi
- Department of Surgical Pathology, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Toshiaki Oharaseki
- Department of Surgical Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nanae Asakawa
- Department of Surgical Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Haruki Makino
- Department of Surgical Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kei Takahashi
- Department of Surgical Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
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Daniels LB, Roberts S, Moreno E, Tremoulet AH, Gordon JB, Burns JC. Long-term health outcomes in young adults after Kawasaki disease. IJC HEART & VASCULATURE 2022; 40:101039. [PMID: 35573651 PMCID: PMC9096130 DOI: 10.1016/j.ijcha.2022.101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
Background We compared the long-term health of adults with prior Kawasaki disease (KD) to controls and determined whether outcomes varied by coronary artery (CA) status. Methods We conducted a prospective cohort study of 258 KD subjects (mean 19 ± 9 years since KD) and 148 age-similar controls who completed extensive health questionnaires. KD subjects were divided into 2 groups, Cohort 1: 109 subjects followed since KD diagnosis at our institution; Cohort 2: 149 KD subjects diagnosed elsewhere. Results KD subjects and controls were of similar age at the time of questionnaire completion (p = 0.50). Overall, 128 subjects (including 60 in Cohort 1) reported normal CAs during and after KD. Compared to controls, KD subjects with normal CAs reported several medical conditions with increased prevalence including migraine headaches, shortness of breath, and leg pain with walking, among others. When limited to Cohort 1, KD subjects were significantly more likely to report chest pain (47% vs 16%, p < 0.001) or palpitations (23% vs 10%, p = 0.01) compared to controls. Prevalence of depression was similar (7% vs 5%, p = 0.73). Conclusions Despite always having normal CAs in the acute and subacute phases of KD, young adults with a history of KD with normal coronaries were more likely than controls to experience cardiovascular symptoms. These differences could be influenced by anxiety or depression, but report of depression was similar between groups. Whether these health differences reflect a heightened awareness of symptoms among KD subjects, or underlying vascular pathology (i.e. vasospasm, microvascular dysfunction, other) merits further study.
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Longitudinal Cardiac Testing in Patients with Kawasaki Disease with No Coronary Involvement: How Much Is Too Much? J Pediatr 2022; 244:10-12. [PMID: 34958829 DOI: 10.1016/j.jpeds.2021.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
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Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis. Radiol Cardiothorac Imaging 2021; 3:e200550. [PMID: 34778780 DOI: 10.1148/ryct.2021200550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.
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Affiliation(s)
- Jenica Thangathurai
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Mariya Kalashnikova
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Masato Takahashi
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Jerold S Shinbane
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
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Clifford AH, Cohen Tervaert JW. Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis. Atherosclerosis 2021; 325:8-15. [PMID: 33873090 DOI: 10.1016/j.atherosclerosis.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur.
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Affiliation(s)
- Alison H Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
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Cardiac events in Patients in their forties with Kawasaki disease and regression of coronary artery aneurysms. Cardiol Young 2020; 30:1821-1825. [PMID: 32912376 DOI: 10.1017/s104795112000284x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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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A machine learning approach to predict intravenous immunoglobulin resistance in Kawasaki disease patients: A study based on a Southeast China population. PLoS One 2020; 15:e0237321. [PMID: 32853226 PMCID: PMC7451628 DOI: 10.1371/journal.pone.0237321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/23/2020] [Indexed: 12/18/2022] Open
Abstract
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, AdaBoost, 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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Farshad S, Halalau A, Townsend W, Schiopu E. Utility of Coronary Calcium Scoring (CCS) in Connective Tissue Disorders (CTDs) for the Evaluation of Subclinical Coronary Atherosclerosis - A Systematic Review. ACR Open Rheumatol 2020; 2:84-91. [PMID: 32043830 PMCID: PMC7011425 DOI: 10.1002/acr2.11107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To assess the current state of knowledge for the utility of coronary calcium scoring (CCS) in connective tissue disorders (CTDs) as it relates to the presence and quantification of coronary atherosclerosis. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, a literature search via PubMed, Embase, Scopus, Web of Science Core Collection, CINAHL, and Cochrane Database of Systematic Review retrieved 1019 studies (since database inception on May 7, 2018) from which 121 manuscripts were eligible for review. Inclusion criteria consisted of studies that investigated CCS in adults with respective CTDs. Studies were excluded if a complete manuscript was not written in English or was a case report. Results Thirty‐one studies were included (27 with healthy age‐/gender‐matched control group for comparison and 4 without). CTDs analyzed in articles with control group: 11 rheumatoid arthritis (RA), 14 systemic lupus erythematosus (SLE), 4 systemic sclerosis (SSc), 1 idiopathic inflammatory myopathies (IIM), 1 Takayasu arteritis, and 1 psoriasis. Nine out of 11 RA studies, 12 out of 14 SLE studies, and 2 out of 4 SSc studies showed statistically significant increased CCS when compared with the control group. CTDs analyzed in studies without control group: two Kawasaki disease, one juvenile idiopathic arthritis (JIA), and one antiphospholipid syndrome (APS) article, which demonstrated increased coronary arterial calcium burden, however, without statistically significant data. Conclusion CTDs, especially SLE and RA, are associated with higher CCS compared with the control group, indicating increased risk of coronary atherosclerosis. Our search did not elicit sufficient publications or statistically significant results in many other CTDs.
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Affiliation(s)
| | - Alexandra Halalau
- Beaumont Health System, Royal Oak, Michigan, and Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Brogan P, Burns JC, Cornish J, Diwakar V, Eleftheriou D, Gordon JB, Gray HH, Johnson TW, Levin M, Malik I, MacCarthy P, McCormack R, Miller O, Tulloh RMR. Lifetime cardiovascular management of patients with previous Kawasaki disease. Heart 2019; 106:411-420. [PMID: 31843876 PMCID: PMC7057818 DOI: 10.1136/heartjnl-2019-315925] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.
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Affiliation(s)
- Paul Brogan
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - Jane C Burns
- Pediatrics, University of California, San Diego, California, USA.,Pediatrics, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Jacqueline Cornish
- National Clinical Director Children, Young People and Transition to Adulthood, Medical Directorate, NHS England, London, UK
| | | | - Despina Eleftheriou
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - John B Gordon
- Cardiology, Sharp Memorial Hospital and San Diego Cardiac Center, San Diego, California, USA
| | | | | | | | - Iqbal Malik
- Imperial College London, International Centre for Circulatory Health, London, UK
| | | | | | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Robert M R Tulloh
- Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Bristol, UK .,University of Bristol, Bristol Heart Institute, Bristol, UK
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Cuglan B, Turhan H, Yetkin E. Letter by Cuglan et al Regarding Article, “Characteristics of Intracranial Aneurysms According to Levels of Coronary Artery Calcium”. Stroke 2019; 50:e272. [DOI: 10.1161/strokeaha.119.026586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bilal Cuglan
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Hasan Turhan
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
| | - Ertan Yetkin
- Department of Cardiology, Istinye University Liv Hospital, Istanbul, Turkey
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Jeudy J, White CS, Kligerman SJ, Killam JL, Burke AP, Sechrist JW, Shah AB, Hossain R, Frazier AA. Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology Archives. Radiographics 2018; 38:11-36. [DOI: 10.1148/rg.2018170175] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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