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Rabinowitz EJ, Rubin LG, Desai K, Hayes DA, Tugertimur A, Kwon EN, Dhanantwari P, Misra N, Stoffels G, Blaufox AD, Mitchell E. Examining the Utility of Coronary Artery Lack of Tapering and Perivascular Brightness in Incomplete Kawasaki Disease. Pediatr Cardiol 2019; 40:147-153. [PMID: 30196380 DOI: 10.1007/s00246-018-1971-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In 2017, the AHA published revised guidelines for the diagnosis of Kawasaki disease (KD). In the absence of compelling data supporting or refuting the utility of lack of tapering (LT) and perivascular brightness (PB), expert panel consensus removed LT and PB from consideration. We hypothesize that LT and PB are unreliable, subjective findings, non-specific to KD, which can be seen in systemic febrile illnesses without KD and in normal controls. METHODS We performed a single-center retrospective study from 1/2008 to 12/2016. De-identified coronary artery (CA) echocardiographic clips from patients 0-10 years old were interpreted blindly by six pediatric cardiologists. Subjects were grouped as follows: (1) healthy: afebrile with benign murmur, (2) KD: IVIG treatment, 4-5 clinical criteria at presentation, (3) incomplete KD (iKD): IVIG, 1-3 clinical criteria, (4) Febrile: ≥3 days of fever, no IVIG, KD not suspected. The presence or absence of LT and PB was recorded. Inter-rater and intra-rater reliabilities were analyzed using intra-class correlation coefficient, Fleiss' Kappa and Cohen's Kappa coefficients. RESULTS We interpreted 117 echocardiograms from healthy (27), KD (30), iKD (32), and febrile (28) subjects. Analysis showed moderate agreement in CA z score measurements. LT and PB were observed by most readers in control groups. LT exhibited fair inter-reader agreement (reliability coefficient 0.36) and PB slight inter-reader agreement (reliability coefficient 0.13). Intra-rater reliability was inconsistent for both parameters. CONCLUSIONS LT and PB are subjective, poorly reproducible features that can be seen in febrile patients without KD and in healthy children.
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Affiliation(s)
- Edon J Rabinowitz
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
| | - Lorry G Rubin
- Division of Pediatric Infectious Disease, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Kinjal Desai
- Department of Pediatrics, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Denise A Hayes
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Aykut Tugertimur
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Elena N Kwon
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Preeta Dhanantwari
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Guillaume Stoffels
- Feinstein Institute Department of Biostatistics, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Andrew D Blaufox
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Elizabeth Mitchell
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York - Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
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Xie L, Wang R, Huang M, Zhang Y, Shen J, Xiao T. Quantitative evaluation of myocardial fibrosis by cardiac integrated backscatter analysis in Kawasaki disease. Cardiovasc Ultrasound 2016; 14:3. [PMID: 26754855 PMCID: PMC4710029 DOI: 10.1186/s12947-016-0046-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/06/2016] [Indexed: 01/02/2023] Open
Abstract
Background Kawasaki disease is an acute, systemic vasculitis that affects the coronary arteries. However, the relationship between myocardial fibrosis and Kawasaki disease has been completely unknown until now. We aimed to provide quantitative information about myocardial fibrosis using cardiac integrated backscatter in Han race Kawasaki disease patients. Methods Ninety Kawasaki disease patients and 90 healthy control subjects were recruited. Based on Kawasaki disease status, the patients were categorized into 3 groups: acute, subacute, and convalescence phase. Based on coronary artery status, the Kawasaki disease patients were categorized into 3 groups: without coronary artery lesions, with coronary artery dilation, and with coronary artery aneurysms. All subjects underwent two-dimensional and Doppler examinations to measure clinical echocardiographic parameters. Myocardial fibrosis was detected with calibrated integrated backscatter imaging. Results Left ventricle systolic functions were normal in both the Kawasaki disease and control participants. The myocardial calibrated integrated backscatter values of the left ventricles of the acute (p < 0.001), subacute (p < 0.001) and convalescence phase (p < 0.001) Kawasaki disease patients were significantly greater than those of the healthy controls. The left ventricle myocardial calibrated integrated backscatter values were significantly smaller in the Kawasaki disease patients without coronary artery lesions than in the Kawasaki disease patients with coronary artery dilations and coronary artery aneurysms in different phases. The left ventricle myocardial calibrated integrated backscatter results were positively correlated with coronary artery status in the acute (r = 0.331, p < 0.001), subacute (r = 0.456, p < 0.001) and convalescence phases (r = 0.407, p < 0.001) of Kawasaki disease. Conclusion Our findings may suggest that myocardial fibrosis occurs during early episodes of Kawasaki disease given uncertainties that exist regarding correlations of calibrated integrated backscatter and myocardial fibrosis.
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Affiliation(s)
- Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China.
| | - Renjian Wang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Yongwei Zhang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
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Sotelo-Cruz N. [A review of Kawasaki disease, a perspective from the articles published in Mexico since January 1977 to May 2012]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 83:214-22. [PMID: 23663892 DOI: 10.1016/j.acmx.2013.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/24/2022] Open
Abstract
Kawasaki disease was described in 1967 by Tomisu Kawasaki. It affects children aged between one and 5 years, and it evolves with fever and small vessel vasculitis, which leads to cardiovascular complications, including coronary aneurisms, myocarditis, valve injuries, pericardial effusion and myocardial infarction; eventually involving many others organs. The etiology actually is not well known, as the exactly pathogenic mechanisms; however, now there are important advances. If the clinical signs and symptoms are identify early and the children received treatment with aspirin and intravenous immunoglobulin, the patients evolves without sequels. The Kawasaki disease is an infrequent disease in Mexico.
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Affiliation(s)
- Norberto Sotelo-Cruz
- Departamento de Medicina y Ciencias de la Salud, Universidad de Sonora, Hermosillo, Sonora, México.
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Nagata H, Yamamura K, Uike K, Nakashima Y, Hirata Y, Morihana E, Mizuno Y, Ishikawa S, Hara T. Evaluation of echogenicity of the heart in Kawasaki disease. Eur J Pediatr 2014; 173:1089-93. [PMID: 24659312 DOI: 10.1007/s00431-014-2296-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/27/2014] [Accepted: 03/04/2014] [Indexed: 12/17/2022]
Abstract
Pathologic studies of the heart in patients with Kawasaki disease (KD) revealed vasculitis, valvulitis, myocarditis, and pericarditis. However, there have been no studies on the quantitative determination of multi-site echogenicity of the heart in KD patients. It is also undetermined whether the degree of echogenicity of each site of the heart in patients with KD might be related to the response to intravenous immunoglobulin (IVIG) treatment. In 81 KD patients and 30 control subjects, we prospectively analyzed echogenicity of the heart. Echogenicity was measured in four sites: coronary artery wall (CAW), mitral valve (MV), papillary muscle (PM), and ascending aortic wall (AAo wall) by the calibrated integrated backscatters (cIBs). The cIB values of all measurement sites at acute phase in KD patients were significantly higher than those in control subjects (KD patients vs control subjects; CAW, 19.8 ± 6.2 dB vs 14.5 ± 2.0 dB, p < 0.05; MV, 23.3 ± 5.3 dB vs 16.0 ± 3.3 dB, p < 0.05; PM, 22.4 ± 5.1 dB vs 12.7 ± 1.9 dB, p < 0.05; AAo wall, 25.3 ± 5.6 dB vs 18.3 ± 3.4 dB, p < 0.05). The cIB values of CAW at the acute phase in IVIG nonresponders were significantly higher than those in responders. Conclusion: Echogenicity of the heart in KD patients at the acute phase increased not only in the coronary artery wall but also in other parts of the heart. Echogenicity of CAW might be helpful in determining the unresponsiveness of IVIG treatment.
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Affiliation(s)
- Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City 812-8582, Japan.
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